These authors sought to determine whether infection rates differ between prophylactic antibiotic use for patients with or without penicillin allergy before shoulder arthroplasty surgery.
They identified 7140 primary shoulder arthroplasties operated between 2005 and 2016. They compared deep surgical site infection risk of patients who received perioperative vancomycin alone (6.2%,N= 444) or clindamycin alone (7.1%, N = 508) for penicillin allergy versus patients who received cefazolin alone without penicillin allergy (86.7%, N = 6,188).
70 deep infections (1.2% 5-year cumulative incidence)were observed. The most common organism was Cutibacterium acnes.
Compared with patients treated with cefazolin, infection risk was not different for those treated with vancomycin (hazard ratio = 1.17, 95% confidence interval 0.42 to 3.30, P = 0.8), but a higher risk of infection was identified for those treated with clindamycin alone (hazard ratio = 3.45, 95% confidence interval 1.84 to 6.47, P , 0.001).
Comment: Cutibacterium is developing an increased resistance to Clindamycin (see this link and this link). Clindamycin has the additional issue of an increased risk of Clostridium difficile bowel infections.
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