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Dreyfuss I, Ramnot A, Jean-Pierre PH, French F, Hernandez L, Nouri K. Review of the Current Antibiotic Guidelines used in Dermatologic Surgery. Dermatol Ther 2022; 35:e15557. [PMID: 35524368 DOI: 10.1111/dth.15557] [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: 01/11/2022] [Revised: 03/17/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022]
Abstract
Antibiotics have been used as a prophylaxis for dermatologic procedures. We will review the various procedures that specific antibiotics with dosages are used for, depending on the procedure, diagnosis, and circumstance of the patient. We will examine the current and updated guidelines used in dermatologic surgery and the overlapping guidelines across other fields. Physicians must consider the side effects of antibiotics and the resistance that may occur as a result before using the class or level of prophylaxis. Initial evaluation for alcohol, chlorhexidine or iodine should be measured as well. Updated guidelines aim to address the contraindications of antibiotics, yet further research is needed to avoid antibiotic resistance and to explore alternative methods of antibiotic application, such as intranasal and intravenous. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Isabella Dreyfuss
- Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine
| | - Amanda Ramnot
- Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine
| | - Philippe H Jean-Pierre
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine
| | - Fabio French
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine
| | - Loren Hernandez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine
| | - Keyvan Nouri
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine
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Tye EY, Taylor AJ, Kay RD, Bryman JA, Andrawis JP, Runner RP. An Orthopedic Surgeon's Dental Examination: Reducing Unnecessary Delays in Joint Replacement Surgery for Marginalized Patients in a Safety Net Hospital System. Arthroplast Today 2021; 12:76-81. [PMID: 34805467 PMCID: PMC8585792 DOI: 10.1016/j.artd.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/01/2021] [Indexed: 12/01/2022] Open
Abstract
Background Selective dental clearance before total joint arthroplasty (TJA) has been proposed; however, effective strategies of carrying out this practice are lacking. This study aims to determine the positive predictive value (PPV) of a novel oral examination performed by an orthopedic surgeon to better direct limited resources for marginalized patients in a safety net hospital system. Methods A retrospective review was conducted on 105 consecutive patients who had an oral examination performed by a single surgeon before elective TJA. Patients who screened negative proceeded to surgery without further formal dental clearance. Patients who screened positive underwent formal examination/intervention by a dentist before surgery. The rate of correct referral that resulted in patients undergoing an oral surgical intervention was determined. Complications during a minimum 90-day postoperative follow-up period were collected and compared. Results Thirty patients (28.6%) screened positive while 75 patients (71.4%) screened negative and proceeded to surgery without referral. The PPV of the screening test was high, with 73.3% of patients receiving a major surgical oral intervention before TJA. Patients sent for formal referral required 89.1 more days to receive their surgery than those that screened negative (54.9 days ± 4.24 vs 144.0 days ± 82.4, P < .001). Conclusion An orthopedic surgeon’s oral examination demonstrates a high PPV to identify high-risk patients in need of an oral surgical intervention before TJA. This provides a unique solution regarding over-referral for preoperative dental clearance and avoids delays for marginalized patients considering elective TJA in a safety net hospital system.
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Affiliation(s)
- Erik Y Tye
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA.,Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
| | - Adam J Taylor
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA.,Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
| | - Robert D Kay
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA.,Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
| | - Jason A Bryman
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA.,Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
| | - John P Andrawis
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA.,Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
| | - Robert P Runner
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA
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Young JR, Bannon AL, Anoushiravani AA, Posner AD, Adams CT, DiCaprio MR. Oral health implications in total hip and knee arthroplasty patients: A review. J Orthop 2021; 24:126-130. [PMID: 33679037 PMCID: PMC7930502 DOI: 10.1016/j.jor.2021.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/14/2021] [Indexed: 12/19/2022] Open
Abstract
Over the past two decades, oral health has emerged as a health care priority. Historically, patients greater than 65 years of age, the economically disadvantaged, members of racial or ethnic minority groups, or the disabled or home bound have experienced significant barriers to routine dental care. The connection between oral health care and periprosthetic joint infections (PJI) continues to be of importance to the orthopedic surgeon, as such infections are significantly morbid and costly. This review aims to introduce the importance of oral health as a small but crucial portion of an arthroplasty patient's overall perioperative management.
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Affiliation(s)
- Joseph R. Young
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Annika L. Bannon
- Department of Family Medicine, Albany Medical Center, Albany, NY, USA
| | | | - Andrew D. Posner
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Curtis T. Adams
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
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Sterility and Infection. Biomed Mater 2021. [DOI: 10.1007/978-3-030-49206-9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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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.
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Liu D, He C, Liu Z, Xu W. Gentamicin coating of nanotubular anodized titanium implant reduces implant-related osteomyelitis and enhances bone biocompatibility in rabbits. Int J Nanomedicine 2017; 12:5461-5471. [PMID: 28814863 PMCID: PMC5546782 DOI: 10.2147/ijn.s137137] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Titanium and titanium alloy are widely used as orthopedic implants for their favorable mechanical properties and satisfactory biocompatibility. The aim of the present study was to investigate the antibacterial effect and bone cell biocompatibility of a novel implant made with nanotubular anodized titanium coated with gentamicin (NTATi-G) through in vivo study in rabbits. The animals were divided into four groups, each receiving different kinds of implants, that is, NTATi-G, titanium coated with gentamicin (Ti-G), nanotubular anodized titanium uncoated with gentamicin (NTATi) and titanium uncoated with gentamicin (Ti). The results showed that NTATi-G implant prevented implant-related osteomyelitis and enhanced bone biocompatibility in vivo. Moreover, the body temperature of rabbits in NTATi-G and Ti-G groups was lower than those in Ti groups, while the weight of rabbits in NTATi-G and Ti-G groups was heavier than those in NTATi and Ti groups, respectively. White blood cell counts in NTATi-G group were lower than NTATi and Ti groups. Features of myelitis were observed by X-ray films in the NTATi and Ti groups, but not in the NTATi-G and Ti-G groups. The radiographic scores, which assessed pathology and histopathology in bone tissues, were significantly lower in the NTATi-G and Ti-G groups than those in the NTATi and Ti groups, respectively (P<0.05). Meanwhile, explants and bone tissue culture demonstrated significantly less bacterial growth in the NTATi-G and Ti-G groups than in the NTATi and Ti groups, respectively (P<0.01). The bone volume in NTATi-G group was greater than Ti-G group, and little bone formation was seen in NTATi and Ti groups.
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Affiliation(s)
- Denghui Liu
- Department of Orthopedics, the 113 Military Hospital, Ningbo
| | - Chongru He
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, People's Republic of China
| | - Zhongtang Liu
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, People's Republic of China
| | - Weidong Xu
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, People's Republic of China
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Rossi AM, Mariwalla K. Prophylactic and Empiric Use of Antibiotics in Dermatologic Surgery: A Review of the Literature and Practical Considerations. Dermatol Surg 2012; 38:1898-921. [DOI: 10.1111/j.1524-4725.2012.02524.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barrington JW, Barrington TA. What is the true incidence of dental pathology in the total joint arthroplasty population? J Arthroplasty 2011; 26:88-91. [PMID: 21723698 DOI: 10.1016/j.arth.2011.03.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 03/23/2011] [Indexed: 02/01/2023] Open
Abstract
One million total joint arthroplasties (TJAs) are performed annually in the United States. The incidence of oral disease has not been documented in this population. To understand the scope of disease, a descriptive longitudinal population-based study sought to define the true incidence of dental pathology in the TJA population. One hundred consecutive TJA patients from a dedicated arthroplasty practice were sent for dental clearance, including oral examination, cleaning, radiographs, and treatment of active decay. The incidence of pathology was documented. Of 10 patients, 23 (23%) were treated before being cleared for arthroplasty. Sixty-six procedures were performed--2.9 problems per patient. No patient developed TJA infection. Routine preoperative dental clearance revealed 23% incidence of pathology, and no patient developed TJA infection.
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Affiliation(s)
- John W Barrington
- Texas Center for Joint Replacement, 5940 W. Parker Rd, #100, Plano, TX 75093, USA
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Mercuri LG, Psutka D. Perioperative, postoperative, and prophylactic use of antibiotics in alloplastic total temporomandibular joint replacement surgery: a survey and preliminary guidelines. J Oral Maxillofac Surg 2011; 69:2106-11. [PMID: 21470752 DOI: 10.1016/j.joms.2011.01.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 01/04/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE In 2009, the American Academy Of Orthopedic Surgeons recommended lifelong prophylaxis after orthopedic total joint replacement (TJR) before these patients undergo dental, aerodigestive, genitourinary (GU), and gastrointestinal (GI) procedures. Because oral and maxillofacial surgeons worldwide are implanting alloplastic total temporomandibular joint replacements (TMJ TJRs), it appeared reasonable to survey these surgeons to obtain data that might shed some light, not only on this issue, but also to obtain some data to begin to develop preliminary guidelines for the peri- and postoperative use of antibiotics for TMJ TJR using these results and the orthopedic data. MATERIALS AND METHODS A total of 35 surgeons worldwide, members of either the TMJ Concepts or Biomet Microfixation online networks were e-mailed a standard questionnaire surveying their perioperative, postoperative, and prophylactic use of antibiotics for their TMJ TJR cases. RESULTS Of the 35 surgeons, 26 (74.2%) from 8 different countries responded. A total of 2,476 cases (3,368 joints) were retrospectively surveyed. Of the responding surgeons, 96.2% used, in order of frequency, cefazolin, clindamycin, cephalosporin, or penicillin-based antibiotics in the perioperative period and continued their use for a mean of 7 days (range 5 to 14) postoperatively. Also, 46.2% soaked the TJR components either in the perioperative antibiotic or in vancomycin, poviodine, gentamycin, or peroxide before implantation. In addition, 61.5% irrigated the wounds after device implantation with bacitracin, vancomycin, poviodine, peroxide, or the perioperative antibiotic. These surgeons reported that 51 joints (1.51%) had become infected within a mean of 6 months (range 2 weeks to 12 years) postoperatively. A total of 32 devices (0.95%) required removal and/or replacement. In cases in which the organisms were isolated, the organisms commonly associated with biofilm infection of TJR devices, Staphylococcus aureus, S epidermidis, Peptostreptococcus, and Pseudamonas aeruginosa, were cultured. In only 1 joint (0.003%) was there a suggestion of an association with an invasive dental/aerodigestive, GU/GI procedure. Regarding prophylaxis after TMJ TJRs and before dental/aerodigestive, GU, or GI procedures, 53.8% of the respondents reported that they provided prophylaxis. Of these, 1 recommended doing this for 6 months and 4 for 2 years, such as has been the American Dental Association/American Academy of Orthopedic Surgeons recommendation since 2003; and 9 reported they believe these TMJ TJR patients should have lifetime antibiotic prophylaxis before invasive dental/aerodigestive, GU, or GI procedures. CONCLUSION The evidence provided from the present small study survey and a review of the orthopedic data could provide the opportunity to develop guidelines for the preoperative, intraoperative, and postoperative antibiotic management for TMJ TJRs and spur additional research into this important area of patient management.
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Shurman DL, Benedetto AV. Antimicrobials in dermatologic surgery: Facts and controversies. Clin Dermatol 2010; 28:505-10. [DOI: 10.1016/j.clindermatol.2010.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Uçkay I, Lübbeke A, Emonet S, Tovmirzaeva L, Stern R, Ferry T, Assal M, Bernard L, Lew D, Hoffmeyer P. Low incidence of haematogenous seeding to total hip and knee prostheses in patients with remote infections. J Infect 2009; 59:337-45. [DOI: 10.1016/j.jinf.2009.08.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 07/08/2009] [Accepted: 08/26/2009] [Indexed: 11/30/2022]
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Kotzé MJ. Prosthetic joint infection, dental treatment and antibiotic prophylaxis. Orthop Rev (Pavia) 2009; 1:e7. [PMID: 21808671 PMCID: PMC3143964 DOI: 10.4081/or.2009.e7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 05/04/2009] [Accepted: 05/22/2009] [Indexed: 11/23/2022] Open
Abstract
Current international and national prophylactic antibiotic regimens have been analyzed in respect of the prevention of bacteremia after dental and surgical procedures and, therefore, of joint prosthesis infection. This information was used to formulate guidelines for the Department of Maxillofacial and Oral Surgery. Publications since 2003 were used in this research. In addition, recommendations of accredited institutions and associations were examined. These included the guidelines of the American Dental Association in association with the American Academy of Orthopaedic Surgeons (2003), the American Heart Association (2007), the Working Party of the British Society for Antimicrobial Chemotherapy (2006) and the Australian Dental Guidelines (2005). No guidelines published by any institution in South Africa were found. The general rationale for the use of antibiotic prophylaxis for surgical (including dental) interventions is that those procedures may result in a bacteremia that may cause infection in joint prostheses. Antibiotics, however, should therefore be administered to susceptible patients, e.g. immunocompromised patients, prior to the development of bacteremia. The guidelines recommended for use in South Africa are based solely on those used outside South Africa. South Africa is regarded as a developing country with its own population and demographic characteristics. Eleven percent of our population is infected with HIV, and a specific guideline for prophylactic antibiotic treatment is, therefore, essential.
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Affiliation(s)
- Marthinus J Kotzé
- Department Maxillofacial and Oral Surgery, School of Dentistry, University of Pretoria, South Africa
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Uçkay I, Pittet D, Bernard L, Lew D, Perrier A, Peter R. Antibiotic prophylaxis before invasive dental procedures in patients with arthroplasties of the hip and knee. ACTA ACUST UNITED AC 2008; 90:833-8. [DOI: 10.1302/0301-620x.90b7.20359] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
More than a million hip replacements are carried out each year worldwide, and the number of other artificial joints inserted is also rising, so that infections associated with arthroplasties have become more common. However, there is a paucity of literature on infections due to haematogenous seeding following dental procedures. We reviewed the published literature to establish the current knowledge on this problem and to determine the evidence for routine antibiotic prophylaxis prior to a dental procedure. We found that antimicrobial prophylaxis before dental interventions in patients with artificial joints lacks evidence-based information and thus cannot be universally recommended.
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Affiliation(s)
- I. Uçkay
- University of Geneva Hospitals and Faculty of Medicine, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
| | - D. Pittet
- University of Geneva Hospitals and Faculty of Medicine, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
| | - L. Bernard
- Raymond Poincaré University Hospital, 104 Boulevard Raymond Poincaré, 92380 Garches, France
| | - D. Lew
- University of Geneva Hospitals and Faculty of Medicine, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
| | - A. Perrier
- University of Geneva Hospitals and Faculty of Medicine, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
| | - R. Peter
- University of Geneva Hospitals and Faculty of Medicine, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
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Scott JF, Morgan D, Avent M, Graves S, Goss AN. Patients with artificial joints: do they need antibiotic cover for dental treatment? Aust Dent J 2006; 50:S45-53. [PMID: 16416718 DOI: 10.1111/j.1834-7819.2005.tb00386.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study reviews whether patients with artificial joints need antibiotic cover for dental treatment. Generally in Australia the practice has developed of giving most patients with artificial joints antibiotic prophylaxis for a wide range of dental procedures. This is partly on anecdotal grounds, partly historical and partly for legal concerns. It has been encouraged by some guidelines. Scientifically, the risk and the benefit of each step in the process needs to be analysed. This review shows that the risk of an artificial joint becoming infected from a bacteraemia of oral origin is exceedingly low whereas the risk of an adverse reaction to the antibiotic prophylaxis is higher than the risk of infection. If all patients with artificial joints receive antibiotic prophylaxis then more will die from anaphylaxis than develop infections. Factors which balance the risk benefit are if the patient is seriously immunocompromised, if the joint prosthesis is failing or chronically inflamed and if the dental procedures, such as from extractions and deep periodontal scaling, produce high level bacteraemias. Recommendations to rationalize antibiotic prophylaxis for patients with artificial joints are presented.
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Affiliation(s)
- J F Scott
- Arthroplasty Group, Australian Orthopaedic Association
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Hendriks JGE, van Horn JR, van der Mei HC, Busscher HJ. Backgrounds of antibiotic-loaded bone cement and prosthesis-related infection. Biomaterials 2004; 25:545-56. [PMID: 14585704 DOI: 10.1016/s0142-9612(03)00554-4] [Citation(s) in RCA: 172] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Antibiotic-loaded bone cement has been in use for over 30 years for the fixation of total joint arthroplasties, although its mechanism of action is still poorly understood. This review presents the backgrounds of bone cements, prosthesis-related infection and antibiotic-loaded bone cements. It is shown that antibiotic-loaded bone cement has a significant effect on bacteria, particularly in animal and clinical studies. However, recently, antimicrobial resistance among bacteria has been ascribed to the antibiotic-loaded bone cement. The unresolved issues both regarding the action of antibiotic-loaded bone cement and the nature of the antimicrobial resistance necessitate further research into the interaction of antibiotic-loaded bone cement and bacteria.
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Affiliation(s)
- J G E Hendriks
- Department of BioMedical Engineering, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
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Abstract
Certain medical conditions and their accompanying drug treatment do have an impact upon oral structures and the delivery of dental care. Recent evidence suggests that oral health could be a significant risk factor for coronary artery disease. Many medical conditions can affect dental care are often over-stated and lack an evidence base. Examples include the need for antibiotic cover in patients at risk from infective endocarditis and the necessity to provide supplementary corticosteroids for those patients on longterm steroid therapy. By contrast, certain systematic drug treatments can have a profound affect on the oral tissue. The most obvious is drug-induced gingival overgrowth. Drugs frequently implicated in this unwanted effect include phenytoin, ciclosporin and the calcium channel blockers. Several risk factors for drug-induced overgrowth have been identified and include age, sex, peridontal variables and a range of drug pharmacokinetic variables. The relationship between oral health and coronary artery disease opens up a potentially new vista for the delivery of oral care. Although the association is convincing, casualty has not been established. If casualty for this relationship can be confirmed then the delivery of dental care and the promotion of oral health will receive a significant impetus.
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Affiliation(s)
- R A Seymour
- School of Dental Sciences, University of Newcastle upon Tyne, Framlington Place, Newcastle upon Tyne NED2 4BW
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Abstract
BACKGROUND AND OVERVIEW In 1997, the American Dental Association and the American Academy of Orthopaedic Surgeons convened an expert panel of dentists, orthopaedic surgeons and infectious disease specialists and published their first Advisory Statement on Antibiotic Prophylaxis for Dental Patients with Prosthetic Joints. This represented the first time that national health organizations had gone on record on this topic. This 2003 advisory statement is the first periodic update of the 1997 statement. In addition, the organizations have created a new patient handout (included at the end of the statement) that dentists may share with their patients. The 1997 Advisory Statement has been well-used by dentists and orthopaedic surgeons. Following their standard protocols for periodic review of existing advisory statements, the ADA and AAOS and their expert consultants recently reviewed the 1997 statement. CONCLUSIONS AND CLINICAL IMPLICATIONS The 2003 statement includes some modifications of the classification of patients at potential risk and of the incidence stratification of bacteremic dental procedures, but no changes in terms of suggested antibiotics and antibiotic regimens. The statement concludes that antibiotic prophylaxis is not indicated for dental patients with pins, plates or screws, nor is it routinely indicated for most dental patients with total joint replacements. However, it is advisable to consider premedication in a small number of patients who may be at potential increased risk of experiencing hematogenous total joint infection.
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Seymour RA, Whitworth JM, Martin M. Antibiotic prophylaxis for patients with joint prostheses - still a dilemma for dental practitioners. Br Dent J 2003; 194:649-53. [PMID: 12830173 DOI: 10.1038/sj.bdj.4810352] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2002] [Accepted: 12/03/2002] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To provide a critical review of the current evidence that implicates dental-induced bacteraemia as a risk for joint infections in patients fitted with joint prostheses and appraise the need for antibiotic prophylaxis. DESIGN Retrospective analysis. SETTING Mainly hospital-based patients or subjects. OUTCOME MEASURES The relationship between joint infections and dental treatment is equivocal at the best and there is no evidence that antibiotic prophylaxis provides such patients with any protection. RESULTS Microbiological evidence linking dental treatment-induced bacteraemia to joint infections is weak and if an oral commensal is implicated, it is more likely to have arisen either from a spontaneous bacteraemia or from a dental infection. As a consequence of the latter, we recommended the institution of good dental health prior to joint replacement. There may be a case for providing prophylaxis to the immuno-compromised patient, but only if the immuno-suppression is associated with a neutropenia. In such circumstances, only emergency treatment should be considered until the neutropenia is resolved. Antibiotic regimens that are recommended by orthopaedic surgeons have not been evaluated in a randomised placebo-controlled study and many of the drugs are not licensed for this purpose. The evidence on cost-risk benefit seems to demonstrate that antibiotic prophylaxis with either amoxicillin or penicillin is not cost effective when compared with no prophylaxis. CONCLUSION The case for providing antibiotic prophylaxis prior to dental treatment in patients fitted with a joint prosthesis is weak or virtually non-existent. Furthermore, the risk from providing prophylaxis is greater than the risk of a joint infection.
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Affiliation(s)
- R A Seymour
- Department of Restorative Dentistry, School of Dental Sciences, University of Newcastle upon Tyne, Framlington Place, NE2 4BW.
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Lucke M, Schmidmaier G, Sadoni S, Wildemann B, Schiller R, Haas NP, Raschke M. Gentamicin coating of metallic implants reduces implant-related osteomyelitis in rats. Bone 2003; 32:521-31. [PMID: 12753868 DOI: 10.1016/s8756-3282(03)00050-4] [Citation(s) in RCA: 219] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Antibiotic prophylaxis is a routine procedure in orthopedic surgery. Various local antibiotic delivery techniques are used to reduce bone- and soft tissue-related infection. The objective of this study was to evaluate the efficacy of a new biodegradable, gentamicin-loaded poly(D,L-lactide) (PDLLA) coating of orthopedic devices in preventing implant-related osteomyelitis. The medullary cavities of tibiae in 30 Sprague Dawley rats were contaminated with Staphylococcus aureus (10(3) colony forming units). Simultaneously titanium Kirschner wires, uncoated (group II), coated with PDLLA (group III), or coated with PDLLA + 10% gentamicin (group IV), were implanted. Ten animals that received phosphate-buffered saline and uncoated Kirschner wires served as controls (group I). Follow-up was 6 weeks. In weekly intervals X-rays of the tibiae were performed, blood counts were taken, and body temperature and weight were determined. After sacrifice infection was evaluated by histological and microbiological analysis. All animals of groups II and III developed microbiological, histological, and radiological signs of infection, including osseous destruction and soft tissue swelling. All animals of the control group remained sterile. Cultures of implants of group IV showed significantly reduced bacterial growth compared to cultures of groups II and III, and three implants of group IV remained sterile. Further radiological and histological signs of infection were significantly reduced in the gentamicin-coated group compared to groups II and III. No significant differences in body weight, body temperature, and blood parameters between all groups were observed. Local application of antibiotic-coated orthopedic devices containing PDLLA and 10% gentamicin significantly reduced implant-related infection in this animal model.
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Affiliation(s)
- M Lucke
- Department of Trauma and Reconstructive Surgery, Charité, Humboldt-University of Berlin, Germany.
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Seymour RA, Whitworth JM. Antibiotic prophylaxis for endocarditis, prosthetic joints, and surgery. Dent Clin North Am 2002; 46:635-51. [PMID: 12436821 DOI: 10.1016/s0011-8532(02)00033-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
It would seem from a review of the evidence that the need for antibiotic prophylaxis in dentistry is overstated. In simple mathematic terms, the risk for providing coverage is greater than the outcomes that could arise if coverage is withheld. In addition, there is the increasing problem of the development of resistant strains and their impact on medicine and dentistry. Yet despite these observations, the profession continues to put their patients at this greater risk. Medico-legal issues do cloud judgments in this area and many dentists err on the side of caution. The profession does require clear, uniform guidelines that are evidence-based. At present, there is still significant debate as to who is at risk from dental-induced bacteremia and what procedures require chemoprophylaxis.
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Affiliation(s)
- Robin A Seymour
- Department of Restorative Dentistry, Dental School, Framlington Place, Newcastle upon Tyne, NE2 4BW, United Kingdom.
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Little JW. Patients with prosthetic joints: are they at risk when receiving invasive dental procedures? SPECIAL CARE IN DENTISTRY 1997; 17:153-60. [PMID: 9791294 DOI: 10.1111/j.1754-4505.1997.tb00888.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Most prosthetic joint infections (PJI) are due to wound contamination at the time of surgery. Some infections occur due to the hematogenous spread of bacteria from distant sites of infection. A review of the literature falls to associate PJI with transient bacteremias from invasive dental procedures. Several authors have described conditions which, they believe, render patients with prosthetic joints more at risk for infection. Prosthetic joint patients with these "high risk" conditions have the same types of infecting organisms as other patients with PJI. This indicates that the infecting bacteria are from wound contamination or distant sites of infection and not related to dental procedure bacteremias. Based on this review, antibiotic prophylaxis is not indicated for patients with prosthetic joints when receiving invasive dental procedures, since there is no proven benefit and there are known risks involved with the use of antibiotics. However, the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS), in an advisory statement, suggest prophylaxis for "high risk" patients. The ADA and AAOS recommend a single dose of amoxicillin, cephradine, or clindamycin when prophylaxis is selected. The dentist is ultimately responsible for making treatment recommendations for his or her patients.
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Advisory statement. Antibiotic prophylaxis for dental patients with total joint replacements. American Dental Association; American Academy of Orthopaedic Surgeons. J Am Dent Assoc 1997; 128:1004-8. [PMID: 9231605 DOI: 10.14219/jada.archive.1997.0307] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
An expert panel of dentists, orthopaedic surgeons and infectious disease specialists convened by the American Dental Association and the American Academy of Orthopaedic Surgeons, or AAOS, performed a thorough review of all available data to determine the need for antibiotic prophylaxis to prevent hematogenous prosthetic joint infections in dental patients who have undergone total joint arthroplasties. The result is this report, which has been adopted by both organizations as an advisory statement. The panel's conclusion: Antibiotic prophylaxis is not indicated for dental patients with pins, plates and screws, nor is it routinely indicated for most dental patients with total joint replacements. However, it is advisable to consider premedication in a small number of patients who may be at potential increased risk of hematogenous total joint infection.
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Affiliation(s)
- T J Pallasch
- Pharmacology Section, School of Dentistry, University of Southern California, Los Angeles, USA
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Simmons NA, Ball AP, Cawson RA, Eykyn SJ, Hughes SP, McGowan DA, Shanson DC. Case against antibiotic prophylaxis for dental treatment of patients with joint prostheses. Lancet 1992; 339:301. [PMID: 1346296 DOI: 10.1016/0140-6736(92)91366-g] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
The three current regimens for the prevention of infective endocarditis are discussed and compared along, with at-risk patients and dentally-induced bacteremias. The principles of antibiotic prophylaxis, and other medical conditions where antibiotic prophylaxis is controversial or inadequately documented is critically analyzed.
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Affiliation(s)
- T J Pallasch
- Department of Periodontology, School of Dentistry, University of Southern California, Los Angeles
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