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dc.contributor.authorRobertsson, Otto
dc.contributor.authorThompson, Olof
dc.contributor.authorW-Dahl, Annette
dc.contributor.authorSundberg, Martin
dc.contributor.authorLidgren, Lars
dc.contributor.authorStefánsdóttir, Anna
dc.date.accessioned2018-03-21T10:41:03Z
dc.date.available2018-03-21T10:41:03Z
dc.date.issued2017-05-11
dc.date.submitted2018
dc.identifier.citationHigher risk of revision for infection using systemic clindamycin prophylaxis than with cloxacillin 2017, 88 (5):562 Acta Orthopaedicaen
dc.identifier.issn1745-3674
dc.identifier.issn1745-3682
dc.identifier.doi10.1080/17453674.2017.1324677
dc.identifier.urihttp://hdl.handle.net/2336/620504
dc.descriptionTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Filesen
dc.description.abstractBackground and purpose - Clindamycin has not been compared with other antibiotics for prophylaxis in arthroplasty. Since 2009, the Swedish Knee Arthroplasty Register (SKAR) has been collecting information on the prophylactic antibiotic regime used at every individual operation. In Sweden, when there is allergy to penicillin, clindamycin has been the recommended alternative. We examined whether there were differences in the rate of revision due to infection depending on which antibiotic was used as systemic prophylaxis. Patients and methods - Patients who had a total knee arthroplasty (TKA) performed due to osteoarthritis (OA) during the years 2009-2015 were included in the study. Information on which antibiotic was used was available for 80,018 operations (55,530 patients). Survival statistics were used to calculate the rate of revision due to infection until the end of 2015, comparing the group of patients who received cloxacillin with those who received clindamycin as systemic prophylaxis. Results - Cloxacillin was used in 90% of the cases, clindamycin in 7%, and cephalosporins in 2%. The risk of being revised due to infection was higher when clindamycin was used than when cloxacillin was used (RR =1.5, 95% CI: 1.2-2.0; p = 0.001). There was no significant difference in the revision rate for other causes (p = 0.2). Interpretation - We advise that patients reporting allergic reaction to penicillin should have their allergic history explored. In the absence of a clear history of type-I allergic reaction (e.g. urticaria, anaphylaxis, or bronchospasm), we suggest the use of a third-generation cephalosporin instead of clindamycin as perioperative prophylaxis when undergoing a TKR. No recommendation can be given regarding patients with type-1 allergy.
dc.language.isoenen
dc.publisherTaylor & Francisen
dc.relation.urlhttps://www.tandfonline.com/doi/full/10.1080/17453674.2017.1324677en
dc.rightsArchived with thanks to Acta Orthopaedicaen
dc.subjectLiðskiptaaðgerðiren
dc.subjectBæklunarlækningaren
dc.subjectHnéen
dc.subjectLyfjaofnæmien
dc.subjectSýklalyfen
dc.subjectORT12en
dc.subject.meshArthroplasty, Replacement, Kneeen
dc.subject.meshPenicillinsen
dc.subject.meshDrug Hypersensitivityen
dc.titleHigher risk of revision for infection using systemic clindamycin prophylaxis than with cloxacillinen
dc.typeArticleen
dc.contributor.department1 ] Lund Univ, Skane Univ Hosp, Swedish Knee Arthroplasty Register, Lund, Sweden [ 2 ] Dept Clin Sci Lund, Orthoped, Lund, Sweden Show more [ 3 ] Skane Univ Hosp, Dept Infect Dis, Lund, Swedenen
dc.identifier.journalActa Orthopaedicaen
dc.rights.accessOpen Access - Opinn aðganguren
dc.contributor.institutionThe Swedish Knee Arthroplasty Register, Lund University, Skåne University Hospital and Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden;
dc.contributor.institutionDepartment of Infectious Diseases, Skåne University Hospital, Lund, Sweden
dc.contributor.institutionThe Swedish Knee Arthroplasty Register, Lund University, Skåne University Hospital and Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden;
dc.contributor.institutionThe Swedish Knee Arthroplasty Register, Lund University, Skåne University Hospital and Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden;
dc.contributor.institutionThe Swedish Knee Arthroplasty Register, Lund University, Skåne University Hospital and Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden;
dc.contributor.institutionThe Swedish Knee Arthroplasty Register, Lund University, Skåne University Hospital and Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden;
dc.departmentcodeORT12
refterms.dateFOA2018-09-12T17:05:46Z
html.description.abstractBackground and purpose - Clindamycin has not been compared with other antibiotics for prophylaxis in arthroplasty. Since 2009, the Swedish Knee Arthroplasty Register (SKAR) has been collecting information on the prophylactic antibiotic regime used at every individual operation. In Sweden, when there is allergy to penicillin, clindamycin has been the recommended alternative. We examined whether there were differences in the rate of revision due to infection depending on which antibiotic was used as systemic prophylaxis. Patients and methods - Patients who had a total knee arthroplasty (TKA) performed due to osteoarthritis (OA) during the years 2009-2015 were included in the study. Information on which antibiotic was used was available for 80,018 operations (55,530 patients). Survival statistics were used to calculate the rate of revision due to infection until the end of 2015, comparing the group of patients who received cloxacillin with those who received clindamycin as systemic prophylaxis. Results - Cloxacillin was used in 90% of the cases, clindamycin in 7%, and cephalosporins in 2%. The risk of being revised due to infection was higher when clindamycin was used than when cloxacillin was used (RR =1.5, 95% CI: 1.2-2.0; p = 0.001). There was no significant difference in the revision rate for other causes (p = 0.2). Interpretation - We advise that patients reporting allergic reaction to penicillin should have their allergic history explored. In the absence of a clear history of type-I allergic reaction (e.g. urticaria, anaphylaxis, or bronchospasm), we suggest the use of a third-generation cephalosporin instead of clindamycin as perioperative prophylaxis when undergoing a TKR. No recommendation can be given regarding patients with type-1 allergy.


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