Prosthetic Joint Infection Following Invasive Dental Procedures and Antibiotic Prophylaxis in Patients With Hip or Knee Arthroplasty

Abstract

OBJECTIVES We aimed to clarify whether invasive dental treatment is associated with increased risk of prosthetic joint infection (PJI) and whether prophylactic antibiotics may lower the infection risk remain unclear. DESIGN Retrospective cohort study. PARTICIPANTS All Taiwanese residents (N=255,568) who underwent total knee or hip arthroplasty between January 1, 1997, and November 30, 2009, were screened. METHODS The dental cohort consisted of 57,066 patients who received dental treatment and were individually matched 1:1 with the nondental cohort by age, sex, propensity score, and index date. The dental cohort was further divided by the use or nonuse of prophylactic antibiotics. The antibiotic and nonantibiotic subcohorts comprised 6,513 matched pairs. RESULTS PJI occurred in 328 patients (0.57%) in the dental subcohort and 348 patients (0.61%) in the nondental subcohort, with no between-cohort difference in the 1-year cumulative incidence (0.6% in both, P=.3). Multivariate-adjusted Cox regression revealed no association between dental procedures and PJI. Furthermore, PJI occurred in 13 patients (0.2%) in the antibiotic subcohort and 12 patients (0.18%) in the nonantibiotic subcohorts (P=.8). Multivariate-adjusted analyses confirmed that there was no association between the incidence of PJI and prophylactic antibiotics. CONCLUSIONS The risk of PJI is not increased following dental procedure in patients with hip or knee replacement and is unaffected by antibiotic prophylaxis. Infect Control Hosp Epidemiol. 2017;38:154-161.

Current prescribing Practices for Antibiotic Prophylaxis: A Survey of Dental Practitioners

“…Uncertainty by dentists may also lead them to prescribe prophylactic antibiotics as a "safety net." 19,30 To avoid uncertainty, Jain et al 24 suggest that dental practitioners should keep the 2007 AHA guidelines somewhere readily accessible or incorporate them into the electronic health record. In 2012, the AAOS in conjunction with the ADA recommended that "practitioners might consider discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic joint implants undergoing dental procedures."…”

“…This could be due to dentists receiving conflicting recommendations from the patient's orthopedic surgeon, or they were uncomfortable providing dental treatment for patients with total joint replacements without antibiotic coverage. 19,25 According to the ADA, antibiotic prophylaxis should be based on the patient's medical history and the evaluation of specific comorbidities. 31 The AHA has outlined the appropriate antibiotic and dosage for patients with high-risk cardiac conditions.…”

“…[11][12][13] Current evidence suggests that dental procedures play a minor role in the development of infective endocarditis and periprosthetic joint infection. [14][15][16][17][18][19] Increased awareness of antibiotic resistance has also questioned the appropriateness and scope of antibiotic prophylaxis use in dentistry.…”

Antibiotics in Endodontics: a review

“…, Kao et al . ). The joint guideline by American Academy of Orthopaedic Surgeons and American Dental…”

“…This is partly on anecdotal grounds, partly historical and partly for legal concerns. A prospective case-control study concluded that dental procedures were not risk factors and the use of antibiotic prophylaxis prior to dental procedures did not decrease the risk of subsequent total hip or knee infection (Berbari et al 2010, Kao et al 2016. The joint guideline by American Academy of Orthopaedic Surgeons and American Dental Association in 2012 (http://www.aaos.org/uploaded Files/PreProduction/Quality/Guidelines_and_Reviews/ PUDP_guideline.pdf) states: 'The practitioner might consider discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic joint implants undergoing dental procedures', but they also recognize that the evidence is limited, and the practitioner should exercise judgment in decision.…”