Clindamycin and bacterial load reduction as prophylaxis for surgical site infection after below-knee flap and graft procedures.
Benjamin Ireland, Ben Lee Tan, Clare Heal et al.
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In 30 seconds
This randomised controlled trial evaluated clindamycin prophylaxis and preoperative chlorhexidine washing in consecutive patients undergoing below-knee flap or graft procedures. Participants received clindamycin, chlorhexidine, or placebo control, and the primary outcome was superficial surgical site infection (SSI) within 30 days. SSI occurred in 14/44 (31.8%) overall. Compared with controls, clindamycin was associated with an overall absolute SSI reduction of 32.4% (95% CI 1.2, 63.6; P = 0.06); among flap repairs, the reduction was 46.2% (95% CI 19.1, 73.3; P <0.05). Chlorhexidine’s reduction was not statistically significant.
Key findings
- SSI occurred in 2/14 (14.3%) clindamycin recipients, 5/15 (33.3%) chlorhexidine recipients, and 7/15 (46.7%) controls.
- Clindamycin’s overall absolute SSI reduction was 32.4% (95% CI 1.2, 63.6; P = 0.06).
- Among flap repairs, clindamycin’s absolute SSI reduction was 46.2% (95% CI 19.1, 73.3; P <0.05).
- Chlorhexidine’s absolute SSI reduction was 13.3% (95% CI -21.4, 48.1; P = 0.456).
Why it matters
Below-knee flap and graft procedures had a substantial SSI burden in this trial. The findings suggest that perioperative clindamycin may reduce infections, with a statistically significant reduction reported for flap repairs, whereas chlorhexidine washing did not show a significant benefit. These results help frame prophylaxis as a question for this procedural context, while the overall clindamycin estimate remains uncertain.
What to keep in mind
The trial included only 44 cases, and the overall clindamycin comparison did not reach statistical significance (P = 0.06).