Antibiotic prophylaxis for Dental Patients with Joint Prostheses? A Decision Analysis

1990 ◽  
Vol 6 (4) ◽  
pp. 569-587 ◽  
Author(s):  
Jed J Jacobson ◽  
Stuart Schweitzer ◽  
David J. DePorter ◽  
J. Jack Lee
Keyword(s):  
Decision Analysis ◽  
Antibiotic Prophylaxis ◽  
Joint Infection ◽  
Cost Effective ◽  
Preventive Strategy ◽  
Dental Patients ◽  
Risk Of Death ◽  
Oral Penicillin ◽  
Prosthetic Joint ◽  
Joint Prostheses

AbstractA decision analysis was performed to assess the risks, costs, and effects of no prophylaxis, oral penicillin, and cephalexin regimens currently being debated for dental patients at risk for late prosthetic joint infection (LPJI). The analysis suggests that there is a very small risk of LPJI (29.3 cases per 106 dental visits), which is outweighed by a greater risk of death with an oral penicillin strategy than with a “no prophylaxis” strategy (2.31:1.93). An oral cephalosporin appears to spare life and limb but does so at an extremely high cost. Over $500,000 must be spent to spare one year of life, while $480,000 needs to be spent to prevent one case of LPJI. Some individual dental patients may still be at a much greater risk for LPJI than others. However, from the evidence to date, routine predental antibiotic prophylaxis for all prosthetic joint patients is a very expensive preventive strategy and is not cost-effective. However, clinical experience suggests that antibiotic prophylaxis may be appropriate in some situations.

scholarly journals Is Antibiotic Prophylaxis Cost-effective for Dental Patients Following Total Knee Arthroplasty?

2018 ◽  
Vol 4 (1) ◽  
pp. 9-18 ◽  
Author(s):  
D.D. Skaar ◽  
T. Park ◽  
M.F. Swiontkowski ◽  
K.M. Kuntz
Keyword(s):  
Total Knee Arthroplasty ◽  
Cost Effectiveness ◽  
Joint Infection ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Decision Modeling ◽  
Dental Patients ◽  
Prosthetic Joint ◽  
Total Knee ◽  
Quality Adjusted Life

Introduction: Routine antibiotic prophylaxis (AP) to prevent prosthetic joint infection remains controversial. The lack of prophylaxis guideline consensus from the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA) contributes to clinician confusion. Objectives: This cost-effectiveness decision model informs the AP debate and guideline development by comparing the benefits, harms, and costs of alternative prophylaxis strategies. Methods: A Markov state-transition model was developed comparing lifetime health outcomes and costs of alternative AP strategies for dental patients aged 65 y with a history of total knee arthroplasty (TKA). Based on our interpretation of AP recommendations from the AAOS and ADA, incremental cost-effectiveness ratios were calculated to compare the following strategies: no AP, AP for the first 2 y after a TKA, and lifetime AP. Results: The no-AP strategy had the lowest average lifetime costs ($17,119) and quality-adjusted life years (11.2151). Compared with a no-prophylaxis strategy, the 2-y AP strategy had incremental costs of $56 and 0.0006 QALYs gained and was cost-effective (incremental cost-effectiveness ratio = $95,100) when a willingness-to-pay threshold of $100,000 per quality-adjusted life year was used. Based on the results of 1-way sensitivity analysis, the no-AP strategy was cost-effective when we modestly increased base case amoxicillin adverse event estimates that were substantially lower than estimates reported in previous models. When plausible combinations of important model parameters were varied, model results suggested that there may be clinical scenarios when AP may be appropriate for some medically at-risk patient populations. Conclusion: The results of cost-effectiveness decision modeling generally support questioning routine AP for dental patients with TKA. Sensitivity analyses suggest that prophylaxis may be cost-effective for patient populations with a higher medical risk of infection. This finding is consistent with the recommendations of the 2015 ADA practice guideline and the appropriate use criteria jointly developed by the AAOS and the ADA. Knowledge Transfer Statement: The results of this decision modeling research support the contention that routine AP before invasive dental procedures to prevent prosthetic joint infection may not be cost-effective for patients without medical conditions, potentially conferring a higher infection risk. Model sensitivity analyses suggest that there may be clinical situations when medically at-risk patients benefit from AP.

scholarly journals Development of a Novel and Rapid Antibody-Based Diagnostic for Chronic Staphylococcus aureus Infections Based on Biofilm Antigens

2020 ◽  
Vol 58 (5) ◽  
Author(s):  
Janette M. Harro ◽  
Mark E. Shirtliff ◽  
William Arnold ◽  
Jennifer M. Kofonow ◽  
Chad Dammling ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Joint Infection ◽  
Cost Effective ◽  
Antibody Detection ◽  
Enzyme Linked Immunosorbent Assay ◽  
Microbial Culture ◽  
Diagnostic Modality ◽  
Content Type ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

ABSTRACT Prosthetic joint infections are difficult to diagnose and treat due to biofilm formation by the causative pathogens. Pathogen identification relies on microbial culture that requires days to weeks, and in the case of chronic biofilm infections, lacks sensitivity. Diagnosis of infection is often delayed past the point of effective treatment such that only the removal of the implant is curative. Early diagnosis of an infection based on antibody detection might lead to less invasive, early interventions. Our study examined antibody-based assays against the Staphylococcus aureus biofilm-upregulated antigens SAOCOL0486 (a lipoprotein), glucosaminidase (a domain of SACOL1062), and SACOL0688 (the manganese transporter MntC) for detection of chronic S. aureus infection. We evaluated these antigens by enzyme-linked immunosorbent assay (ELISA) using sera from naive rabbits and rabbits with S. aureus-mediated osteomyelitis, and then we validated a proof of concept for the lateral flow assay (LFA). The SACOL0688 LFA demonstrated 100% specificity and 100% sensitivity. We demonstrated the clinical diagnostic utility of the SACOL0688 antigen using synovial fluid (SF) from humans with orthopedic implant infections. Elevated antibody levels to SACOL0688 in clinical SF specimens correlated with 91% sensitivity and 100% specificity for the diagnosis of S. aureus infection by ELISA. We found measuring antibodies levels to SACOL0688 in SF using ELISA or LFA provides a tool for the sensitive and specific diagnosis of S. aureus prosthetic joint infection. Development of the LFA diagnostic modality is a desirable, cost-effective option, potentially providing rapid readout in minutes for chronic biofilm infections.

scholarly journals Micromonas micros Infection of a Prosthetic Hip Joint: A Case Report and Review of the Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Abhimanyu Aggarwal ◽  
Durane Walker
Keyword(s):  
Antibiotic Prophylaxis ◽  
Hip Joint ◽  
Joint Infection ◽  
Dental Procedure ◽  
Joint Infections ◽  
Prosthetic Joints ◽  
Prosthetic Joint ◽  
Dental Procedures ◽  
Prosthetic Joint Infections ◽  
Hematogenous Seeding

Micromonas micros is an oral anaerobic Gram-positive coccus and is a commensal of the mouth, and it is rarely isolated in prosthetic joint infections (PJIs) and even less frequently related to a preceding dental procedure with eventual hematogenous seeding of the prosthetic joint. Here, we present a case of a 56-year-old male with a prosthetic hip joint who developed Micromonas micros prosthetic hip joint infection with symptoms starting a few days after a dental procedure and not having received periprocedural antibiotic prophylaxis. He recovered well with surgical intervention and antimicrobial therapy. We conducted a literature review of prosthetic hip joint infections caused by Micromonas micros as well as briefly discuss current guidelines on antibiotic prophylaxis in patients with prosthetic joints undergoing dental procedures and some knowledge gaps.

scholarly journals Extended Antibiotic Prophylaxis May Be Linked to Lower Peri-prosthetic Joint Infection Rates in High-Risk Patients: An Evidence-Based Review

2019 ◽  
Vol 15 (3) ◽  
pp. 297-301 ◽  
Author(s):  
Christopher J. DeFrancesco ◽  
Michael C. Fu ◽  
Cynthia A. Kahlenberg ◽  
Andy O. Miller ◽  
Mathias P. Bostrom
Keyword(s):  
High Risk ◽  
Antibiotic Prophylaxis ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Evidence Based ◽  
Infection Rates ◽  
High Risk Patients ◽  
Prosthetic Joint ◽  
Risk Patients

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

2016 ◽  
Vol 38 (2) ◽  
pp. 154-161 ◽  
Author(s):  
Feng-Chen Kao ◽  
Yao-Chun Hsu ◽  
Wen-Hui Chen ◽  
Jiun-Nong Lin ◽  
Ying-Ying Lo ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Prosthetic Joint Infection ◽  
Cox Regression ◽  
Dental Treatment ◽  
Joint Infection ◽  
Prophylactic Antibiotics ◽  
Prosthetic Joint ◽  
Dental Procedures ◽  
Cohort Difference ◽  
Increased Risk

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

scholarly journals Prosthetic joint infection, dental treatment and antibiotic prophylaxis

2009 ◽  
Vol 1 (1) ◽  
pp. 7 ◽  
Author(s):  
Marthinus J. Kotzé
Keyword(s):  
South Africa ◽  
Antibiotic Prophylaxis ◽  
Dental Treatment ◽  
Oral Surgery ◽  
Joint Infection ◽  
Prophylactic Antibiotic ◽  
Working Party ◽  
Heart Association ◽  
British Society ◽  
Joint Prostheses

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.

scholarly journals Antibiotic Tolerance of Staphylococcus aureus Biofilm in Periprosthetic Joint Infections and Antibiofilm Strategies

Antibiotics ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 547
Author(s):  
Fabien Lamret ◽  
Marius Colin ◽  
Céline Mongaret ◽  
Sophie C. Gangloff ◽  
Fany Reffuveille
Keyword(s):  
Staphylococcus Aureus ◽  
Biofilm Formation ◽  
Population Aging ◽  
Joint Infection ◽  
Stress Factors ◽  
Host Cells ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Joint Prostheses ◽  
Orthopedic Prosthesis

The need for bone and joint prostheses is currently growing due to population aging, leading to an increase in prosthetic joint infection cases. Biofilms represent an adaptive and quite common bacterial response to several stress factors which confer an important protection to bacteria. Biofilm formation starts with bacterial adhesion on a surface, such as an orthopedic prosthesis, further reinforced by matrix synthesis. The biofilm formation and structure depend on the immediate environment of the bacteria. In the case of infection, the periprosthetic joint environment represents a particular interface between bacteria, host cells, and the implant, favoring biofilm initiation and maturation. Treating such an infection represents a huge challenge because of the biofilm-specific high tolerance to antibiotics and its ability to evade the immune system. It is crucial to understand these mechanisms in order to find new and adapted strategies to prevent and eradicate implant-associated infections. Therefore, adapted models mimicking the infectious site are of utmost importance to recreate a relevant environment in order to test potential antibiofilm molecules. In periprosthetic joint infections, Staphylococcus aureus is mainly involved because of its high adaptation to the human physiology. The current review deals with the mechanisms involved in the antibiotic resistance and tolerance of Staphylococcus aureus in the particular periprosthetic joint infection context, and exposes different strategies to manage these infections.

Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis: a nationwide cohort study using Danish healthcare registers

2017 ◽  
Vol 77 (2) ◽  
pp. 281-288 ◽  
Author(s):  
Rene Lindholm Cordtz ◽  
Kristian Zobbe ◽  
Pil Højgaard ◽  
Lars Erik Kristensen ◽  
Søren Overgaard ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Total Knee Arthroplasty ◽  
Cohort Study ◽  
Knee Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Risk Of Death ◽  
Prosthetic Joint ◽  
Increased Risk ◽  
Total Knee

ObjectivesTo investigate predictors of 10-year risk of revision and 1-year risk of prosthetic joint infection (PJI) and death following total hip/total knee arthroplasty (THA/TKA) in (1) patients with rheumatoid arthritis (RA) compared with patients with osteoarthritis (OA); and (2) patients with RA treated with biological disease-modifying antirheumatic drugs (bDMARD) within 90 days preceding surgery compared with non-treated.MethodsRegister-based cohort study using the Danish National Patient Register, the DANBIO rheumatology register (RA-specific confounders and treatment episodes) and the Danish Hip and Knee Arthroplasty Registers. Survival analyses were used to calculate confounder-adjusted sub-HRs (SHR) and HRs.ResultsIn total, 3913 patients with RA with THA/TKA were compared with 120 499 patients with OA. Patients with RA had decreased risk of revision (SHR 0.71 (0.57–0.89)), but increased risk of PJI (SHR=1.46 (1.13–1.88)) and death (HR=1.25 (1.01–1.55)). In DANBIO, 345 of 1946 patients with RA with THA/TKA had received bDMARD treatment within 90 days preceding surgery. bDMARD-treated patients did not have a statistically significant increased risk of revision (SHR=1.49 (0.65–3.40)), PJI (SHR=1.61 (0.70–3.69)) nor death (HR=0.75 (0.24–2.33)) compared with non-treated. Glucocorticoid exposure (HR=2.87 (1.12–7.34)) and increasing DAS28 (HR=1.49 (1.01–2.20)) were risk factors for mortality.ConclusionPatients with RA had a decreased 10-year risk of revision while the risk of death and PJI was increased compared with patients with OA following THA/TKA. bDMARD exposure was not associated with statistically significant increased risk of neither PJI nor death in this study. Glucocorticoid exposure and increased disease activity were associated with an increased risk of death.

A Clinical Decision Analysis for Use of Antibiotic Prophylaxis for Nonabsorbable Nasal Packing

2021 ◽  
pp. 019459982098874
Author(s):  
Ximena Maul ◽  
Berkay C. Dincer ◽  
Arthur W. Wu ◽  
Andrew V. Thamboo ◽  
Thomas S. Higgins ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Decision Analysis ◽  
Antibiotic Prophylaxis ◽  
Cost Effective ◽  
Clinical Decision ◽  
Antibiotic Use ◽  
Quality Adjusted Life Year ◽  
Nasal Packing ◽  
Level Of Evidence

Objective Nonabsorbable nasal packing is often placed for the treatment of epistaxis or after sinonasal or skull base surgery. Antibiotics are often prescribed to prevent toxic shock syndrome (TSS), a rare, potentially fatal occurrence. However, the risk of TSS must be balanced against the major risk of antibiotic use, specifically Clostridium difficile colitis (CDC). The purpose of this study is to evaluate in terms of cost-effectiveness whether antibiotics should be prescribed when nasal packing is placed. Study Design A clinical decision analysis was performed using a Markov model to evaluate whether antibiotics should be given. Setting Patients with nonabsorbable nasal packing placed. Methods Utility scores, probabilities, and costs were obtained from the literature. We assess the cost-effectiveness of antibiotic use when the risk of community-acquired CDC is balanced against the risk of TSS from nasal packing. Sensitivity analysis was performed for assumptions used in the model. Results The incremental cost-effectiveness ratio for antibiotic use was 334,493 US dollars (USD)/quality-adjusted life year (QALY). Probabilistic sensitivity analysis showed that not prescribing antibiotics was cost-effective in 98.0% of iterations at a willingness to pay of 50,000 USD/QALY. Sensitivity analysis showed that when the risk of CDC from antibiotics was greater than 910/100,000 or when the incidence of TSS after nasal packing was less than 49/100,000 cases, the decision to withhold antibiotics was cost-effective. Conclusions Routine antibiotic prophylaxis in the setting of nasal packing is not cost-effective and should be reconsidered. Even if antibiotics are assumed to prevent TSS, the risk of complications from antibiotic use is of greater consequence. Level of Evidence 3a

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