1
|
Tabaja H, Abu Saleh OM, Osmon DR. Periprosthetic Joint Infection: What's New? Infect Dis Clin North Am 2024:S0891-5520(24)00058-8. [PMID: 39261141 DOI: 10.1016/j.idc.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Total joint arthroplasty (TJA) ranks among the most commonly performed orthopedic surgeries, with its annual incidence on the rise globally. Periprosthetic joint infection (PJI) remains a leading cause of arthroplasty failure. This review aims to summarize recent literature updates on the epidemiology, diagnosis, and management of PJI.
Collapse
Affiliation(s)
- Hussam Tabaja
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Omar M Abu Saleh
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Douglas R Osmon
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
2
|
Park HJ, Koh K, Choi YJ, Suh DH, D'Lima D, Kim JG. Is Prophylactic Antibiotic Use Necessary Before Dental Procedures in Primary and Revision TKA? A Propensity Score-matched, Large-database Study. Clin Orthop Relat Res 2024; 482:411-422. [PMID: 38231150 PMCID: PMC10871784 DOI: 10.1097/corr.0000000000002966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/05/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND The question of whether dental procedures increase the risk of periprosthetic joint infection (PJI) in patients who have undergone total joint arthroplasty (TJA) remains controversial. QUESTIONS/PURPOSES (1) Are dental procedures associated with an increased incidence of PJI in the setting of either primary or revision TKA after controlling for relevant potentially confounding variables? (2) Is the administration of prophylactic antibiotics before dental procedures associated with any differences in this risk? (3) Which factors are associated with increased incidence of PJI after dental procedures? METHODS This nationwide, retrospective, comparative, large-database study evaluated 591,602 patients who underwent unilateral primary or revision TKA between 2009 and 2019 using the Health Insurance Review and Assessment Service data in South Korea, in which all people in South Korea were registered and to which all medical institutions must charge any procedures they performed. The study population was divided into 530,156 patients with dental procedures and 61,446 patients without dental procedures based on whether the patients underwent a dental procedure at least 1 year after the index surgery. After propensity score matching, patients were classified into a dental (n = 182,052) and a nondental cohort (n = 61,422). The dental cohort was then divided into two groups: 66,303 patients with prophylactic antibiotics and 115,749 patients without prophylactic antibiotics based on prophylactic antibiotic use. After propensity score matching, patients were categorized into prophylactic (n = 66,277) and nonprophylactic (n = 66,277) cohorts. Propensity score matching was used to control for covariates including posttraumatic arthritis associated with PJI risk according to the dental procedure and prophylactic antibiotic use among the cohorts. After propensity score matching, the standardized mean difference was confirmed to be less than 0.1 for all variables. Kaplan-Meier survival analyses, log-rank tests, and Cox proportional hazards regression analysis was performed. RESULTS Dental procedures were not associated with an increase in PJI risk after primary (adjusted HR 1.56 [95% CI 0.30 to 8.15]; p = 0.60) or revision TKA (adjusted HR 1.74 [95% CI 0.90 to 3.34]; p = 0.10). Additionally, use of prophylactic antibiotics was not associated with a reduced PJI risk after the index surgery, either for primary (adjusted HR 1.28 [95% CI 0.30 to 5.42]; p = 0.74) or revision TKA (adjusted HR 0.74 [95% CI 0.45 to 1.23]; p = 0.25). Although surgery type and prophylactic antibiotic use exhibited no influence on PJI occurrence after dental procedures, posttraumatic arthritis was associated with PJI. The adjusted HR for posttraumatic arthritis was 4.54 (p = 0.046). CONCLUSION Our findings suggest that dental procedures were not associated with an increased risk of PJI for up to 2 years after the dental procedure in patients who underwent either primary or revision TKA. Based on these findings, there is insufficient rationale for the use of prophylactic antibiotics before dental procedures in patients who have undergone primary or revision TKA. LEVEL OF EVIDENCE Level III, therapeutic study.
Collapse
Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Korea University College of Medicine, Ansan Hospital, Ansan-si, Gyeongki-do, South Korea
| | - Kyeol Koh
- Department of Dentistry, Catholic University College of Medicine, Eunpyeong St. Mary's Hospital, Seoul, South Korea
- Department of Dental Science, Graduate School, Chosun University, Gwangju, South Korea
| | - Yoon Ji Choi
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Ansan Hospital Ansan-si, Gyeongki-do, South Korea
| | - Dong Hun Suh
- Department of Orthopedic Surgery, Korea University College of Medicine, Ansan Hospital, Ansan-si, Gyeongki-do, South Korea
| | - Darryl D'Lima
- The Scripps Research Institute and Shiley Center for Orthopedic Research and Education, La Jolla, CA, USA
| | - Jae Gyoon Kim
- Department of Orthopedic Surgery, Korea University College of Medicine, Ansan Hospital, Ansan-si, Gyeongki-do, South Korea
- The Scripps Research Institute and Shiley Center for Orthopedic Research and Education, La Jolla, CA, USA
| |
Collapse
|
3
|
de Oliveira RCG, Gardev E, Shaddox LM. Dysbiotic relationship between arthritis and the oral-gut microbiome. A critical review. J Periodontal Res 2022; 57:711-723. [PMID: 35583216 DOI: 10.1111/jre.13002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/18/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
Arthritis and prosthetic joint infections (PJIs) overall are associated with reduced quality of life and limited work capacity. Multiple, overlapping factors contribute to these conditions. Some investigations have suggested a dysbiotic association between the oral-gut microbiome and pathogenesis of arthritis and PJIs. A better understanding of the role of the oral-gut microbiota in arthritis and PJI pathophysiology can shed light into how its disequilibrium can discharge a pro-inflammatory response, and impact the health of patients susceptible to arthritis or with established joint disease. A review of published in vivo and clinical data suggested that alterations in oral and gut microbiota can lead to a disturbance of immunoregulatory properties, and may be associated with joint infections and arthritis. This review brings new insights into the current status of the evidence on the potential molecules and inflammatory biomarkers disrupted by an oral-gut microbial dysbiosis. Normal commensals and pathogenic oral and gut microflora homeostasis are important not only to prevent infections per se but also its potential progression. Further experiments, especially controlled clinical trials, are needed to ascertain how microbiome manipulation and other microbiota-directed approaches can help control inflammation and effectively prevent and treat arthritic diseases. Additionally, studies on the effects of the long-term oral diseases, such as chronic periodontitis, on arthritis and PJIs need to be conducted.
Collapse
Affiliation(s)
- Rubelisa Candido Gomes de Oliveira
- Center for Oral Health Research, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA.,College of Dentistry, Federal University of Goias, Goiania, Goias, Brazil
| | - Elly Gardev
- Arizona State University, Tempe, Arizona, USA
| | - Luciana Macchion Shaddox
- Division of Periodontology and Center for Oral Health Research, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
4
|
Rigotti E, Bianchini S, Nicoletti L, Monaco S, Carrara E, Opri F, Opri R, Caminiti C, Donà D, Giuffré M, Inserra A, Lancella L, Mugelli A, Piacentini G, Principi N, Tesoro S, Venturini E, Staiano A, Villani A, Sesenna E, Vicini C, Esposito S. Antimicrobial Prophylaxis in Neonates and Children Undergoing Dental, Maxillo-Facial or Ear-Nose-Throat (ENT) Surgery: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:antibiotics11030382. [PMID: 35326845 PMCID: PMC8944694 DOI: 10.3390/antibiotics11030382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 12/10/2022] Open
Abstract
Surgical site infections (SSIs) represent a potential complication in surgical procedures, mainly because clean/contaminated surgery involves organs that are normally colonized by bacteria. Dental, maxillo-facial and ear-nose-throat (ENT) surgeries are among those that carry a risk of SSIs because the mouth and the first respiratory tracts are normally colonized by a bacterial flora. The aim of this consensus document was to provide clinicians with recommendations on surgical antimicrobial prophylaxis in neonates (<28 days of chronological age) and pediatric patients (within the age range of 29 days−18 years) undergoing dental, maxillo-facial or ENT surgical procedures. These included: (1) dental surgery; (2) maxilla-facial surgery following trauma with fracture; (3) temporo-mandibular surgery; (4) cleft palate and cleft lip repair; (5) ear surgery; (6) endoscopic paranasal cavity surgery and septoplasty; (7) clean head and neck surgery; (8) clean/contaminated head and neck surgery and (9) tonsillectomy and adenoidectomy. Due to the lack of pediatric data for the majority of dental, maxillo-facial and ENT surgeries and the fact that the recommendations for adults are currently used, there is a need for ad hoc studies to be rapidly planned for the most deficient areas. This seems even more urgent for interventions such as those involving the first airways since the different composition of the respiratory microbiota in children compared to adults implies the possibility that surgical antibiotic prophylaxis schemes that are ideal for adults may not be equally effective in children.
Collapse
Affiliation(s)
- Erika Rigotti
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (F.O.); (R.O.); (G.P.)
| | - Sonia Bianchini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
| | - Laura Nicoletti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
| | - Sara Monaco
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
| | - Elena Carrara
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy;
| | - Francesca Opri
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (F.O.); (R.O.); (G.P.)
| | - Roberta Opri
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (F.O.); (R.O.); (G.P.)
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy;
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy;
| | - Mario Giuffré
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90134 Palermo, Italy;
| | - Alessandro Inserra
- General Surgery Department, Bambino Gesu Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy;
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (L.L.); (A.V.)
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139 Florence, Italy;
| | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (F.O.); (R.O.); (G.P.)
| | | | - Simonetta Tesoro
- Division of Anesthesia, Analgesia, and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, 06129 Perugia, Italy;
| | - Elisabetta Venturini
- Pediatric Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy;
| | - Alberto Villani
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (L.L.); (A.V.)
| | - Enrico Sesenna
- Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, 43126 Parma, Italy;
| | - Claudio Vicini
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Piertoni Hospital, 47121 Forli, Italy;
| | - Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
- Correspondence: ; Tel.: +39-0521-903524
| | | |
Collapse
|
5
|
Salgado-Peralvo AO, Peña-Cardelles JF, Kewalramani N, Garcia-Sanchez A, Mateos-Moreno MV, Velasco-Ortega E, Ortiz-García I, Jiménez-Guerra Á, Végh D, Pedrinaci I, Monsalve-Guil L. Is Antibiotic Prophylaxis Necessary before Dental Implant Procedures in Patients with Orthopaedic Prostheses? A Systematic Review. Antibiotics (Basel) 2022; 11:93. [PMID: 35052970 PMCID: PMC8773220 DOI: 10.3390/antibiotics11010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/28/2021] [Accepted: 01/10/2022] [Indexed: 12/10/2022] Open
Abstract
As the population ages, more and more patients with orthopaedic prostheses (OPs) require dental implant treatment. Surveys of dentists and orthopaedic surgeons show that prophylactic antibiotics (PAs) are routinely prescribed with a very high frequency in patients with OPs who are about to undergo dental procedures. The present study aims to determine the need to prescribe prophylactic antibiotic therapy in patients with OPs treated with dental implants to promote their responsible use and reduce the risk of antimicrobial resistance. An electronic search of the MEDLINE database (via PubMed), Web of Science, LILACS, Google Scholar, and OpenGrey was carried out. The criteria used were those described by the PRISMA® Statement. No study investigated the need to prescribe PAs in patients with OPs, so four studies were included on the risk of infections of OPs after dental treatments with varying degrees of invasiveness. There is no evidence to suggest a relationship between dental implant surgeries and an increased risk of OP infection; therefore, PAs in these patients are not justified. However, the recommended doses of PAs in dental implant procedures in healthy patients are the same as those recommended to avoid infections of OPs.
Collapse
Affiliation(s)
- Angel-Orión Salgado-Peralvo
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (A.-O.S.-P.); (E.V.-O.); (I.O.-G.); (Á.J.-G.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
| | - Juan-Francisco Peña-Cardelles
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
- Department of Basic Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
- Fellow Oral and Maxillofacial Surgery Department and Prosthodontics Department, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA
| | - Naresh Kewalramani
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
- Department of Nursery and Stomatology, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Alvaro Garcia-Sanchez
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA;
| | - María-Victoria Mateos-Moreno
- Department of Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Eugenio Velasco-Ortega
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (A.-O.S.-P.); (E.V.-O.); (I.O.-G.); (Á.J.-G.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
| | - Iván Ortiz-García
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (A.-O.S.-P.); (E.V.-O.); (I.O.-G.); (Á.J.-G.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
| | - Álvaro Jiménez-Guerra
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (A.-O.S.-P.); (E.V.-O.); (I.O.-G.); (Á.J.-G.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
| | - Dániel Végh
- Department of Prosthodontics, Semmelweis University, 1085 Budapest, Hungary;
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, 8010 Graz, Austria
| | - Ignacio Pedrinaci
- Section of Graduate Periodontology, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain;
- Department of Restorative Dentistry and Biomaterials Science, Harvard School of Dental Medicine, Harvard University, Boston, MA 02115, USA
| | - Loreto Monsalve-Guil
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (A.-O.S.-P.); (E.V.-O.); (I.O.-G.); (Á.J.-G.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
| |
Collapse
|
6
|
Katz JN, Song ZS, Stanley EE, Lenhard NK, Silva GS, Chen A, Thornhill TS, Lange J, Collins JE, Selzer F, Losina E. Factors associated with use of antibiotic prophylaxis following dental procedures in total joint replacement recipients. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100217. [PMID: 36474765 PMCID: PMC9718251 DOI: 10.1016/j.ocarto.2021.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022] Open
Abstract
Background Total joint replacement recipients (TJR) are at risk for prosthetic joint infection (PJI), particularly those with comorbidities such as diabetes mellitus (DM) and rheumatoid arthritis (RA). Methods We mailed surveys to 1078 subjects undergoing primary TJR between 2011 and 2016 at an academic center. The survey asked about medical, dental, and orthopedic history and use of antibiotics prior to dental appointments. We generated adjusted relative risks (aRR) for using antibiotic prophylaxis less than always using Poisson regression, adjusting for demographic, clinical, and behavioral factors. Results We received surveys from 639 subjects; 597 were eligible and formed the analytical sample. 66 % reported always using antibiotic prophylaxis. DM and RA were not associated with prophylaxis use. Factors associated with less frequent use included: BMI ≥30 (aRR = 1.27, 95 % CI [1.01, 1.60]), dental cleanings <2 times/year (aRR = 1.95, 95 % CI [1.56, 2.43]), and expressing little concern (compared to neutral) about getting PJI (aRR = 1.23, 95 % CI [0.97, 1.55]), though this association was not statistically significant. Greater antibiotic use was reported in subjects who had ≥3 TJRs, (aRR = 0.48, 95 % CI [0.29, 0.80]), underwent more invasive dental procedures (aRR = 0.74, 95 % CI [0.59, 0.93]), and were concerned (vs. neutral) about PJI (aRR = 0.53, 95 %CI [0.33, 0.84]). Conclusions Two-thirds of TJR recipients in an academic center reported always using antibiotic prophylaxis prior to dental visits. Usage rates varied by demographics, BMI, number of TJRs, type of dental procedure, and behavioral factors -- but not by comorbidities associated with higher PJI risk.
Collapse
Affiliation(s)
- Jeffrey N. Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Zoey S. Song
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Elizabeth E. Stanley
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Nora K. Lenhard
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Genevieve S. Silva
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Angela Chen
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Thomas S. Thornhill
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Jeffrey Lange
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Jamie E. Collins
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Faith Selzer
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| |
Collapse
|
7
|
Buonavoglia A, Leone P, Solimando AG, Fasano R, Malerba E, Prete M, Corrente M, Prati C, Vacca A, Racanelli V. Antibiotics or No Antibiotics, That Is the Question: An Update on Efficient and Effective Use of Antibiotics in Dental Practice. Antibiotics (Basel) 2021; 10:550. [PMID: 34065113 PMCID: PMC8151289 DOI: 10.3390/antibiotics10050550] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022] Open
Abstract
The antimicrobial resistance (AMR) phenomenon is an emerging global problem and is induced by overuse and misuse of antibiotics in medical practice. In total, 10% of antibiotic prescriptions are from dentists, usually to manage oro-dental pains and avoid postsurgical complications. Recent research and clinical evaluations highlight new therapeutical approaches with a reduction in dosages and number of antibiotic prescriptions and recommend focusing on an accurate diagnosis and improvement of oral health before dental treatments and in patients' daily lives. In this article, the most common clinical and operative situations in dental practice, such as endodontics, management of acute alveolar abscesses, extractive oral surgery, parodontology and implantology, are recognized and summarized, suggesting possible guidelines to reduce antibiotic prescription and consumption, maintaining high success rates and low complications rates. Additionally, the categories of patients requiring antibiotic administration for pre-existing conditions are recapitulated. To reduce AMR threat, it is important to establish protocols for treatment with antibiotics, to be used only in specific situations. Recent reviews demonstrate that, in dentistry, it is possible to minimize the use of antibiotics, thoroughly assessing patient's conditions and type of intervention, thus improving their efficacy and reducing the adverse effects and enhancing the modern concept of personalized medicine.
Collapse
Affiliation(s)
- Alessio Buonavoglia
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Patrizia Leone
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Antonio Giovanni Solimando
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Rossella Fasano
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Eleonora Malerba
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Marcella Prete
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | | | - Carlo Prati
- Endodontic Clinical Section, Department of Biomedical and NeuroMotor Sciences, Dental School, University of Bologna, 40125 Bologna, Italy;
| | - Angelo Vacca
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Vito Racanelli
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| |
Collapse
|
8
|
Goff DA, Mangino JE, Glassman AH, Goff D, Larsen P, Scheetz R. Review of Guidelines for Dental Antibiotic Prophylaxis for Prevention of Endocarditis and Prosthetic Joint Infections and Need for Dental Stewardship. Clin Infect Dis 2021; 71:455-462. [PMID: 31728507 DOI: 10.1093/cid/ciz1118] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022] Open
Abstract
Dentists prescribe 10% of all outpatient antibiotic prescriptions, writing more than 25.7 million prescriptions per year. Many are for prophylaxis in patients with prosthetic joint replacements; the American Dental Society states that "in general," prophylactic antibiotics are not recommended to prevent prosthetic joint infections. Orthopedic surgeons are concerned with the risk of implant infections following a dental procedure and, therefore, see high value and low risk in recommending prophylaxis. Patients are "stuck in the middle," with conflicting recommendations from orthopedic surgeons (OS) and dentists. Unnecessary prophylaxis and fear of lawsuits amongst private practice dentists and OS has not been addressed. We review The American Heart Association/American College of Cardiology, American Dental Association, and American Association of Orthopedic Surgeons' guidelines on dental antibiotic prophylaxis for the prevention of endocarditis and prosthetic joint infections. We provide experience on how to engage private-practice dentists and OS in dental stewardship using a community-based program.
Collapse
Affiliation(s)
- Debra A Goff
- The Ohio State University Wexner Medical Center, The Ohio State University College of Pharmacy, Columbus, Ohio, USA
| | - Julie E Mangino
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Andrew H Glassman
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Douglas Goff
- Drs. Gilbert and Goff Prosthodontists, Columbus, Ohio, USA
| | - Peter Larsen
- Division of Oral and Maxillofacial Surgery and Dental Anesthesiology, The Ohio State University College of Dentistry, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard Scheetz
- Drs. Scheetz and Rekos Oral and Facial Surgeons of Ohio, Dublin, Ohio, USA
| |
Collapse
|
9
|
File TM, Bleasdale SC. Early Steps Toward Ambulatory Antimicrobial Stewardship: Dental and Orthopedic Focus. Clin Infect Dis 2021; 71:463-465. [PMID: 31728516 DOI: 10.1093/cid/ciz1124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/13/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Thomas M File
- Division of Infectious Diseases, Summa Health, Akron, Ohio, USA
| | - Susan C Bleasdale
- Internal Medicine, Division of Infectious Diseases, University of Illinois at Chicago, Chicago, Illinois, USA
| |
Collapse
|
10
|
Morgan MA, Goldstein EJ. Bulleidia extructa: An underappreciated anaerobic pathogen. Anaerobe 2021; 69:102339. [PMID: 33596467 DOI: 10.1016/j.anaerobe.2021.102339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/19/2022]
Abstract
Bulleidia extructa is a rarely recognized anaerobic Gram-positive bacterium with an oral and gastroenterological ecological niche. It is difficult to isolate due to slow growth in culture and usually requires identification techniques such as 16S rRNA gene sequencing or matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS). While most often isolated from infections related to the oral cavity (gingivitis, periodontitis, brain and lung abscess), it has also been recovered from cases of prosthetic joint hip infections after unprophylaxed dental procedures.
Collapse
Affiliation(s)
- Margie A Morgan
- Microbiology Laboratory, Cedars Sinai Medical Center, Los Angeles, CA, 90048, USA
| | | |
Collapse
|
11
|
Danilkowicz RM, Lachiewicz AM, Lorenzana DJ, Barton KD, Lachiewicz PF. Prosthetic Joint Infection After Dental Work: Is the Correct Prophylaxis Being Prescribed? A Systematic Review. Arthroplast Today 2021; 7:69-75. [PMID: 33521200 PMCID: PMC7818599 DOI: 10.1016/j.artd.2020.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/12/2020] [Accepted: 11/11/2020] [Indexed: 02/02/2023] Open
Abstract
Background Prosthetic joint infection (PJI) of total hip (THA) or total knee arthroplasty (TKA) after dental procedures is uncommon, and antibiotic prophylaxis remains controversial. For high-risk patients, the American Academy of Orthopedic Surgeons recommends amoxicillin prophylaxis. However, no systematic review of the literature of PJIs associated with dental procedures explores if amoxicillin is suitable for the reported organisms. Methods A librarian-assisted search of the major databases (PubMed, Medline, Embase, Scopus) identified 954 articles. Only case reports, case series, and reviews with patient level data were included. After exclusions, 79 articles were fully reviewed. Results Forty-four PJIs after dental procedures were identified, 22 in primary THA, 20 in primary TKA, one in revision THA, and one in a hip resurfacing procedure. Antibiotic prophylaxis was documented for 5 patients. The dental procedure was invasive in 35 (79.5%). Comorbidities were present in 17 patients (38.7%). The organisms reported were Streptococcus spp. in 44%, other aerobic gram-positives in 27%, anaerobic gram-positives in 18%, and gram-negative organisms in 11%. An estimated 46% of organisms may be resistant to amoxicillin. The outcomes of treatment were reported for 35 patients (79.5%). Twenty-seven patients (61.4%) had no clinical signs of PJI at the final follow-up visit. Conclusions Lower extremity PJI associated with dental procedures is often caused by organisms unlikely to be prevented with amoxicillin. Additional studies are warranted to determine the choice and efficacy of antibiotic prophylaxis to prevent dental-associated PJI in the highest risk patients. Insufficient data exist to recommend the optimal treatment for patients with PJI in THA and TKA associated with dental procedures.
Collapse
Affiliation(s)
| | - Anne M Lachiewicz
- Division of Infectious Diseases, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | | | - Karen D Barton
- Duke University Medical Center Library & Archives, Durham, NC, USA
| | - Paul F Lachiewicz
- Department of Orthopedic Surgery, Duke University, Durham, NC, USA.,Durham Veteran's Administration Medical Center, Durham, NC, USA
| |
Collapse
|
12
|
Stanley EE, Trentadue TP, Smith KC, Sullivan JK, Thornhill TS, Lange J, Katz JN, Losina E. Cost-effectiveness of dental antibiotic prophylaxis in total knee arthroplasty recipients with type II diabetes mellitus. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100084. [PMID: 36474886 PMCID: PMC9718342 DOI: 10.1016/j.ocarto.2020.100084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/06/2020] [Indexed: 02/06/2023] Open
Abstract
Objective Type II diabetes mellitus (T2DM) is prevalent in knee osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA) and increases risk for prosthetic joint infection (PJI). We examined the cost-effectiveness of antibiotic prophylaxis (AP) before dental procedures to reduce PJI in TKA recipients with T2DM. Design We used the Osteoarthritis Policy Model, a validated computer simulation of knee OA, to compare two strategies among TKA recipients with T2DM (mean age 68 years, mean BMI 35.4 kg/m2): 1) AP before dental procedures and 2) no AP. Outcomes included quality-adjusted life expectancy (QALE) and lifetime medical costs. We used published efficacy of AP. We report incremental cost-effectiveness ratios (ICERs) and considered strategies with ICERs below well-accepted willingness-to-pay (WTP) thresholds cost-effective. We conducted sensitivity analyses to examine the robustness of findings to uncertainty in model input parameters. We used a lifetime horizon and healthcare sector perspective. Results We found that AP added 1.0 quality-adjusted life-year (QALY) and $66,000 for every 1000 TKA recipients with T2DM, resulting in an ICER of $66,000/QALY. In sensitivity analyses, reduction of the probability of PJI, T2DM-associated risk of infection, or attribution of infections to dental procedures by 50% resulted in ICERs exceeding $100,000/QALY. Probabilistic sensitivity analyses showed that AP was cost-effective in 32% and 58% of scenarios at WTP of $50,000/QALY and $100,000/QALY, respectively. Conclusions AP prior to dental procedures is cost-effective for TKA recipients with T2DM. However, the cost-effectiveness of AP depends on the risk of PJI and efficacy of AP in this population.
Collapse
Affiliation(s)
- Elizabeth E. Stanley
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA
| | - Taylor P. Trentadue
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA
| | - Karen C. Smith
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA
| | - James K. Sullivan
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA
| | - Thomas S. Thornhill
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey Lange
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey N. Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
- Departments of Epidemiology and Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
13
|
Posalski I, Morgan MA, Riley ME, Goldstein EJC. Bulleidia extructa Prosthetic Hip Infection After a Dental Procedure: Potential Need for Prophylaxis. Clin Infect Dis 2020; 73:e849-e850. [DOI: 10.1093/cid/ciaa1625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Irving Posalski
- Infectious Diseases Division, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Margie A Morgan
- Microbiology Laboratory, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Michelle E Riley
- Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | | |
Collapse
|
14
|
Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining. J Clin Med 2020; 9:jcm9072190. [PMID: 32664491 PMCID: PMC7408657 DOI: 10.3390/jcm9072190] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023] Open
Abstract
A projected increased use of total joint arthroplasties will naturally result in a related increase in the number of prosthetic joint infections (PJIs). Suppression of the local peri-implant immune response counters efforts to eradicate bacteria, allowing the formation of biofilms and compromising preventive measures taken in the operating room. For these reasons, the prevention of PJI should focus concurrently on the following targets: (i) identifying at-risk patients; (ii) reducing “bacterial load” perioperatively; (iii) creating an antibacterial/antibiofilm environment at the site of surgery; and (iv) stimulating the local immune response. Despite considerable recent progress made in experimental and clinical research, a large discrepancy persists between proposed and clinically implemented preventative strategies. The ultimate anti-infective strategy lies in an optimal combination of all preventative approaches into a single “clinical pack”, applied rigorously in all settings involving prosthetic joint implantation. In addition, “anti-infective” implants might be a choice in patients who have an increased risk for PJI. However, further progress in the prevention of PJI is not imaginable without a close commitment to using quality improvement tools in combination with continual data mining, reflecting the efficacy of the preventative strategy in a particular clinical setting.
Collapse
|
15
|
Slullitel PA, Oñativia JI, Piuzzi NS, Higuera-Rueda C, Parvizi J, Buttaro MA. Is there a Role for Antibiotic Prophylaxis Prior to Dental Procedures in Patients with Total Joint Arthroplasty? A Systematic Review of the Literature. J Bone Jt Infect 2020; 5:7-15. [PMID: 32117684 PMCID: PMC7045525 DOI: 10.7150/jbji.40096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/13/2019] [Indexed: 12/29/2022] Open
Abstract
Background: The indication of prophylactic antibiotics prior to dental procedures for non-infected causes in order to reduce the risk of haematogenous periprosthetic joint infection (PJI) remains as controversial. We performed a systematic review of the literature assessing the relationship between PJI and invasive dental procedures and whether there is evidence to support the use of antibiotic prophylaxis. Methods: This review was conducted in accordance with the 2009 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were searched for studies focusing on dental procedures after TJA, reporting on PJI as an outcome. The methodological quality was assessed with the Newcastle-Ottawa quality assessment scale for case-control and cohort studies and by the tool proposed by Murad et al. for observational studies. Results: Our systematic literature review yielded 90 individual studies, of which 9 met the inclusion criteria. The overall infection rate ranged from 0.26% to 2.12%. Of these, cases associated with a dental procedure ranged from 0% to 15.9%. Five of the studies described cases in which antibiotic prophylaxis was administered; however, no clear algorithm regarding type and dosage of antibiotic was mentioned. When assessing the methodological quality of the evidence, all studies had an overall low to moderate quality. Conclusion: The current systematic review, mostly composed of low-quality studies, suggests that there is no direct evidence to indicate prophylactic antibiotics prior to dental procedures in patients with TJA. In line with the current guidelines, no prophylaxis should be used on interventions for non-infected causes, except for occasional unusual situations, which can then be judged individually.
Collapse
Affiliation(s)
- Pablo Ariel Slullitel
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - José Ignacio Oñativia
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Nicolás Santiago Piuzzi
- Adult Reconstructive Surgery, Division of Orthopaedic Surgery, Cleveland Clinic, Ohio, United States
| | - Carlos Higuera-Rueda
- Adult Reconstructive Surgery, Division of Orthopaedic Surgery, Cleveland Clinic, Ohio, United States
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; United States
| | - Martín Alejandro Buttaro
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
16
|
Moreira AI, Mendes L, Pereira JA. Is there scientific evidence to support antibiotic prophylaxis in patients with periodontal disease as a means to decrease the risk of prosthetic joint infections? A systematic review. INTERNATIONAL ORTHOPAEDICS 2019; 44:231-236. [PMID: 31754752 DOI: 10.1007/s00264-019-04433-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/03/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE To re-assess the scientific literature to ascertain if there is scientific evidence to support antibiotic prophylaxis in patients with periodontal disease as a means to decrease the risk of prosthetic joint infections. INTRODUCTION Prosthetic joint infections occur in approximately 0.3-2% of patients and, of these, around 6-13% are thought to be caused by oral bacteria. Antibiotic prophylaxis prior to dental procedures as a means to prevent a prosthetic joint infection has been controversial throughout the years. However, it remains unclear to what extent it has a beneficial effect. We do know that bacteraemia of oral origin is directly proportional to any ongoing inflammation or infection, and that a diseased periodontium may act as an entry for bacteria to spread to distant locations, through the bloodstream, and potentially be the cause of distant site infections. MATERIALS AND METHODS Updated literature search using the PubMed (Medline), and the Clarivate Analytics databases, to identify eligible articles since the previous searches up to April 2019 (last 5 years). RESULTS No studies that relate periodontal disease to the development of a prosthetic joint infection were found. CONCLUSION Currently, there is no evidence to support or exclude the need of antibiotic prophylaxis as a means to decrease the risk of prosthetic joint infections in patients with periodontal disease.
Collapse
Affiliation(s)
- Ana Isabel Moreira
- Faculty of Dental Medicine of University of Porto, Rua Dr. Manuel Pereira da Silva, 4200-393, Porto, Portugal.
| | - Luzia Mendes
- Faculty of Dental Medicine of University of Porto, Rua Dr. Manuel Pereira da Silva, 4200-393, Porto, Portugal
| | - José António Pereira
- Faculty of Dental Medicine of University of Porto, Rua Dr. Manuel Pereira da Silva, 4200-393, Porto, Portugal
| |
Collapse
|
17
|
Dental assessment prior to orthopedic surgery: A systematic review. Orthop Traumatol Surg Res 2019; 105:761-772. [PMID: 31060914 DOI: 10.1016/j.otsr.2019.02.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND To reduce the risk of infection after orthopedic surgery, patients are asked to undergo preoperative assessments in various medical domains. However, to our knowledge, there has been no systematic review to evaluate the performance of a preoperative dental assessment before orthopedic surgery. We focus on two questions as follows: (1) is there a link between the presence of preoperative dental assessment and orthopedic infections?; (2) is the probability of an orthopedic infection increased in the presence of dental risk factors and comorbidities? PATIENTS AND METHODS Databases including PubMed, the Cochrane Library databases and Google Scholar were searched for English-language articles until November 2018. The inclusion criteria were descriptions of infections of joint prostheses and dental infections, and potential dental origins of pathogenic infections. Studies dealing with oral assessments performed before orthopedic surgery were included. RESULTS Based on eligibility criteria, 12 case series, 4 case-control studies and 12 cohort studies were included. In case-controls, prosthesis infection was presumably associated with a dental abscess in 6/224 of cases (2.9%). In cohort studies, exposure was defined as "any dental assessment or dental treatment performed before surgery". Even if only 4 cohort studies provide this information exposure, it would seem that the presence of an infectious complication is less frequent if the preoperative examination has been performed. Dental treatment given before surgery was mainly for scaling-polishing in 78/205 (38%), extraction in 49/205 of cases (24%) and restorative work in 37/205 (18%). DISCUSSION The literature review was made complex by the substantial heterogeneity among included studies. Although there is no formal evidence for or against preoperative dental assessment, it is advisable to perform this with the aim of maintaining favorable oral hygiene and thus reduce the risk factors. LEVEL OF EVIDENCE Level III, systematic review.
Collapse
|
18
|
Arnold WV, Bari AK, Buttaro M, Huang R, Mirez JP, Neira I, Poojary A, Purtill JJ, Quevedo MS, García Ricaurte JC, Scuderi G, Thakur H, Tozun IR. General Assembly, Prevention, Postoperative Factors: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S169-S174. [PMID: 30348574 DOI: 10.1016/j.arth.2018.09.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
|
19
|
Noori N, Myerson C, Charlton T, Thordarson D. Is Antibiotic Prophylaxis Necessary Before Dental Procedures in Patients Post Total Ankle Arthroplasty? Foot Ankle Int 2019; 40:237-241. [PMID: 30406674 DOI: 10.1177/1071100718809454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: The need for dental antibiotic prophylaxis after orthopedic surgery remains unclear. Current recommendations are based on patients with total hip and total knee arthroplasties. We investigated available evidence regarding the need for dental antibiotic prophylaxis in patients post foot and ankle surgery, specifically total ankle arthroplasty. Additionally, we examined the microbiology behind the risk of transient bacteremia from dental procedures and whether this leads to an increased risk for postoperative infection in foot and ankle surgery. METHODS: We performed a MEDLINE literature review of English articles between 1980 and 2018 on patients with prosthetic joints undergoing dental work, and studies evaluating hematogenous prosthetic joint infection (PJI) and dental antibiotic prophylaxis. We additionally included articles on PJI post total ankle arthroplasty, as well as committee guidelines. RESULTS: There is no literature at present that evaluates transient bacteremia with dental procedures in patients following foot and ankle surgery. The data on this topic are isolated to PJI rates in the context of hip and total knee arthroplasty. This is of particular interest as rates of total ankle arthroplasty PJI have been reported to be 2- to 4-fold higher than in hip and total knee arthroplasty. CONCLUSION: The concern for postoperative infection due to transient bacteremia without dental antibiotic prophylaxis can be extrapolated to patients undergoing foot and ankle surgeries. Some data suggest that oral cavity bacteria can seed a prosthetic joint, though no clear relationship has been demonstrated. Similar risk factors have been identified between hip and knee PJI and total ankle arthroplasty. In light of the absence of scrutiny of and guidelines on this topic in foot and ankle surgery, it may be advisable to apply similar principles to decision-making in patients after foot and ankle surgery. LEVEL OF EVIDENCE: Level III, systematic review.
Collapse
Affiliation(s)
| | - Charles Myerson
- 2 Tulane University School of Medicine, New Orleans, LA, USA
| | | | | |
Collapse
|
20
|
Donovan TE, Marzola R, Murphy KR, Cagna DR, Eichmiller F, McKee JR, Metz JE, Albouy JP, Troeltzsch M. Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2018; 120:816-878. [DOI: 10.1016/j.prosdent.2018.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 02/08/2023]
|
21
|
Rakow A, Perka C, Trampuz A, Renz N. Origin and characteristics of haematogenous periprosthetic joint infection. Clin Microbiol Infect 2018; 25:845-850. [PMID: 30678837 DOI: 10.1016/j.cmi.2018.10.010] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/14/2018] [Accepted: 10/16/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Recognition of infectious origin of haematogenous periprosthetic joint infections (PJI) is crucial. We investigated the primary focus and characteristics of haematogenous PJI. METHODS Consecutive patients who presented with haematogenous PJI between 01/2010 and 01/2018 were retrospectively analysed. Haematogenous PJI was defined by diagnosis of infection ≥1 month after surgery, acute manifestation after a pain-free period and positive blood or prosthetic-site culture and/or evidence of distant infectious focus consistent with the pathogen. Fisher's exact, Student's t and Mann-Whitney U tests were used, as appropriate. RESULTS A total of 106 episodes of PJI were included, involving 59 knee, 45 hip, one shoulder and one elbow prostheses. The median time from last surgery until haematogenous PJI was 47 months (range, 1-417 months). The pathogen was identified in 105 episodes (99%), including Staphylococcus aureus (n = 43), streptococci (n = 32), enterococci (n = 13), Gram-negative bacteria (n = 9) and coagulase-negative staphylococci (n = 8). Gram-negative bacteria were significantly more often found in hip joints than in knee joints. Blood cultures grew the pathogen in 43 of 70 episodes (61%). The primary infectious focus was identified in 72 episodes (68%) and included infections of intravascular devices or heart valves (22 episodes), skin and soft tissue (16 episodes), the oral cavity (12 episodes), urogenital (12 episodes) or gastrointestinal tract (seven episodes) and other sites (three episodes). CONCLUSIONS In acute PJI manifesting after a pain-free period, the haematogenous infection route should be considered and the primary infectious focus should be actively searched for. The cardiovascular system, skin and soft tissue, oral cavity, urogenital and gastrointestinal tracts were common origins of haematogenous PJI.
Collapse
Affiliation(s)
- A Rakow
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany
| | - C Perka
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - A Trampuz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - N Renz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany.
| |
Collapse
|