The primary objective of this retrospective study was to determine whether patients with a reported allergy to penicillin have an increased risk of postsurgical infections after sinus lifts and onlay grafts.

A retrospective cohort study was performed on patients who underwent bone reconstruction procedures between October 2018 and December 2020.

Data from all patients operated in one University Hospital for sinus lift or onlay grafts were collected.

All surgical procedures studied were performed under preoperative and postoperative antibiotic coverage with either amoxicillin +/- clavulanic acid or clindamycin for patients with reported penicillin allergy. Bone graft-associated infections were recorded. Graft failures were also reported.

In this study, 111 patients received bone reconstructions (89 sinus lift, 148 onlay grafts).

Among sinus lift, infections occurred in 5 of 89 sites (5.6 %).

However, the infection rate was 28.5 % (7 graft sites) for clindamycin and only 3.9 % (82 graft sites) for amoxicillin.

Among onlay graft procedures, infections occurred in 25 of 148 sites (16.8 %).

However, the infection rate was 56 % (18 graft sites) for clindamycin and only 12 % for amoxicillin (130 graft sites).

Penicillin-allergic patients taking clindamycin had a higher risk of infection with an odd ratio of 7.8 (95 % CI 1.1-54.8, P=0.04) and 4.8 (95 % CI 1.9-12.3, P=0.001) compared with non-allergic patients taking amoxicillin for onlay grafts and sinus lift.

Penicillin allergy labelling resulting in a clindamycin use after sinus lift and procedures were associated with a higher rate of infection and may be a risk factor for complications related to bone reconstruction surgery. Our data on postoperative infections are consistent with the literature. Penicillin-allergy de-labelling strategy prior to surgery may impact these infection and is now implemented in our center

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