Artificial Joints Not at Risk for Infection After Dental Work
Artificial Joints Not at Risk for Infection After Dental Work
By Michael Smith, North American Correspondent, MedPage Today
Published: October 27, 2008
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
WASHINGTON, Oct. 27 -- Contrary to common wisdom and accepted practice, there is no point in giving prophylactic antibiotics before dental procedures to ward off infection in prosthetic joints, a researcher said here.
Action Points
Explain to interested patients that antibiotic prophylaxis is often given to people with artificial joints who are undergoing dental work.
Note that this study suggests the procedure has no effect.
Note that this study was published as an abstract and presented in poster form at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Both the American Dental Association and the American Academy of Orthopaedic Surgeons urge such prophylaxis, but the suggestion is based only on expert opinion, said Elie Berbari, M.D., of the Mayo Clinic, in Rochester, Minn.
Yet in a single-center prospective case-control study, there was no evidence that antibiotics had any effect on the risk of infection in artificial joints, Dr. Berbari said at the Interscience Conference on Antimicrobial Agents and Chemotherapy, held jointly with the Infectious Diseases Society of America meeting.
The result is not as conclusive as a randomized clinical trial, Dr. Berbari said, but such a study is unlikely to be conducted because of cost. "This is the best evidence we have," he said.
Dr. Berbari and colleagues studied 339 patients admitted to their hospital from December 2001 through April 2006 with infection in a total knee or total hip arthroplasty.
Controls were 339 patients, also with artificial joints, but without infection, he said.
The researchers collected data on demographic factors and potential risk factors, as well as obtaining data on dental procedures -- from each patient's dentist and doctor -- for the two years before the infection.
Dental procedures were classed as either low- or high-risk. Low-risk procedures included such things as restorative dentistry or fluoride treatment, while high-risk procedures included periodontal treatment or extractions.
The mean age of the cases was 69.5 years and they had had their artificial joints for 15.5 months on average. In comparison, controls had an average age of 71.4 and they had had their joints for an average of 49.9 months.
Several factors were significant risk factors for infection, including diabetes, prior arthroplasty, and compromised immunity, but antibiotic prophylaxis before dental procedures had no effect, the researchers found.
Specifically:
For low-risk procedures, 41 cases and 65 controls did not have antibiotics, for an odds ratio of 0.6, with a 95% confidence interval of 0.4 to 1.1.
Also for low-risk procedures, 59 cases and 87 controls had antibiotics, for an odds ratio of 0.8, with a 95% confidence interval of 0.5 to 1.2.
For high-risk procedures, 33 cases and 49 controls didn't have antibiotics, while 95 and 148 did, for odds ratios of 0.8 and 0.7 respectively.
As in the low-risk procedures, both 95% confidence intervals crossed unity, so the result was not significant.
Dr. Berbari said the notion of antibiotic prophylaxis before dental work in patients with artificial joints "should be re-evaluated."
He noted that the number of artificial joints implanted yearly in the U.S. is projected to rise to about four million by 2030.
Unneeded antibiotic prophylaxis for those people "is going to be a big issue," he said, especially with the rise of antibiotic resistance.
The study comes as some authorities are suggesting fewer uses of antibiotics, according to Lindsay Grayson, M.D., of the Austin Hospital in Melbourne, Australia, who was not part of the study.
In endocarditis, for instance, new guidelines suggest that antibiotics should be used less often, especially for dental procedures, said Dr. Grayson, a member of the program committee for the joint meeting. (See: Endocarditis Prevention Dropped from Endoscopy Guidelines)
"They're a little contentious, because everyone is used to giving antibiotics, he said, "and most of us have erred on the side of prophylaxis."
The Mayo study isn't definitive, but "you would need a massive number of patients" to get a solid answer in a randomized trial, he said.
Dr. Berbari did not report any external sources of support or any conflicts.
Primary source: ICAAC-IDSA Meeting
Source reference:
Berbari E, et al "Prosthetic Joint Infection (PJI) Due to Dental Procedures" ICAAC-IDSA 2008; Abstract K-551.
By Michael Smith, North American Correspondent, MedPage Today
Published: October 27, 2008
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
WASHINGTON, Oct. 27 -- Contrary to common wisdom and accepted practice, there is no point in giving prophylactic antibiotics before dental procedures to ward off infection in prosthetic joints, a researcher said here.
Action Points
Explain to interested patients that antibiotic prophylaxis is often given to people with artificial joints who are undergoing dental work.
Note that this study suggests the procedure has no effect.
Note that this study was published as an abstract and presented in poster form at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Both the American Dental Association and the American Academy of Orthopaedic Surgeons urge such prophylaxis, but the suggestion is based only on expert opinion, said Elie Berbari, M.D., of the Mayo Clinic, in Rochester, Minn.
Yet in a single-center prospective case-control study, there was no evidence that antibiotics had any effect on the risk of infection in artificial joints, Dr. Berbari said at the Interscience Conference on Antimicrobial Agents and Chemotherapy, held jointly with the Infectious Diseases Society of America meeting.
The result is not as conclusive as a randomized clinical trial, Dr. Berbari said, but such a study is unlikely to be conducted because of cost. "This is the best evidence we have," he said.
Dr. Berbari and colleagues studied 339 patients admitted to their hospital from December 2001 through April 2006 with infection in a total knee or total hip arthroplasty.
Controls were 339 patients, also with artificial joints, but without infection, he said.
The researchers collected data on demographic factors and potential risk factors, as well as obtaining data on dental procedures -- from each patient's dentist and doctor -- for the two years before the infection.
Dental procedures were classed as either low- or high-risk. Low-risk procedures included such things as restorative dentistry or fluoride treatment, while high-risk procedures included periodontal treatment or extractions.
The mean age of the cases was 69.5 years and they had had their artificial joints for 15.5 months on average. In comparison, controls had an average age of 71.4 and they had had their joints for an average of 49.9 months.
Several factors were significant risk factors for infection, including diabetes, prior arthroplasty, and compromised immunity, but antibiotic prophylaxis before dental procedures had no effect, the researchers found.
Specifically:
For low-risk procedures, 41 cases and 65 controls did not have antibiotics, for an odds ratio of 0.6, with a 95% confidence interval of 0.4 to 1.1.
Also for low-risk procedures, 59 cases and 87 controls had antibiotics, for an odds ratio of 0.8, with a 95% confidence interval of 0.5 to 1.2.
For high-risk procedures, 33 cases and 49 controls didn't have antibiotics, while 95 and 148 did, for odds ratios of 0.8 and 0.7 respectively.
As in the low-risk procedures, both 95% confidence intervals crossed unity, so the result was not significant.
Dr. Berbari said the notion of antibiotic prophylaxis before dental work in patients with artificial joints "should be re-evaluated."
He noted that the number of artificial joints implanted yearly in the U.S. is projected to rise to about four million by 2030.
Unneeded antibiotic prophylaxis for those people "is going to be a big issue," he said, especially with the rise of antibiotic resistance.
The study comes as some authorities are suggesting fewer uses of antibiotics, according to Lindsay Grayson, M.D., of the Austin Hospital in Melbourne, Australia, who was not part of the study.
In endocarditis, for instance, new guidelines suggest that antibiotics should be used less often, especially for dental procedures, said Dr. Grayson, a member of the program committee for the joint meeting. (See: Endocarditis Prevention Dropped from Endoscopy Guidelines)
"They're a little contentious, because everyone is used to giving antibiotics, he said, "and most of us have erred on the side of prophylaxis."
The Mayo study isn't definitive, but "you would need a massive number of patients" to get a solid answer in a randomized trial, he said.
Dr. Berbari did not report any external sources of support or any conflicts.
Primary source: ICAAC-IDSA Meeting
Source reference:
Berbari E, et al "Prosthetic Joint Infection (PJI) Due to Dental Procedures" ICAAC-IDSA 2008; Abstract K-551.
Comments