Review of Guidelines for Dental Antibiotic Prophylaxis for Prevention of Endocarditis and Prosthetic Joint Infections and Need for Dental Stewardship

2019 ◽  
Vol 71 (2) ◽  
pp. 455-462 ◽  
Author(s):  
Debra A Goff ◽  
Julie E Mangino ◽  
Andrew H Glassman ◽  
Douglas Goff ◽  
Peter Larsen ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Private Practice ◽  
Heart Association ◽  
Dental Procedure ◽  
Community Based ◽  
Joint Replacements ◽  
Joint Infections ◽  
Orthopedic Surgeons ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

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.

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.

Preoperative antibiotic prophylaxis in prosthetic joint infections: not a concern for intraoperative cultures

2016 ◽  
Vol 86 (4) ◽  
pp. 442-445 ◽  
Author(s):  
Daniel Pérez-Prieto ◽  
María E. Portillo ◽  
Lluís Puig-Verdié ◽  
Albert Alier ◽  
Carlo Gamba ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Preoperative Antibiotic Prophylaxis

scholarly journals Diagnostični protokol za obravnavo okuženih sklepnih vsadkov

2015 ◽  
Vol 84 (6) ◽  
Author(s):  
Alen Mlekuž ◽  
Rihard Trebše ◽  
Rene Mihalič ◽  
Vesna Levašič
Keyword(s):  
Absolute Number ◽  
Low Grade ◽  
Joint Infections ◽  
Orthopedic Surgeons ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Early Failures ◽  
Increased Sensitivity ◽  
To Come ◽  
Ongoing Infection

Infection is becoming the most important as well as the most devastating mechanism of prosthetic joint failure. The incidence is increasing due to increased sensitivity of orthopedic surgeons for this diagnosis, better diagnostics, and  because the absolute number of operated patients is increasing and because more often very sick, debilitated, and immunocompromised patients are operated on. The trend shows the incidence to further increase in the years to come. The diagnosis may be very easy in case of high grade processes, but also extremely difficult in low grade infections. Misdiagnosing infection leads to repeat early failures and revisions that are distressing for patients as well as for surgeons. To avoid failures related to misdiagnosed prosthetic joint infections a step-wise algorithm of action is proposed and the diagnostic strength of the steps discussed. The key point is to select the potential candidates to define the possibility of an ongoing infection and then to select the tools to strengthen the suspicion. The further procedures base on the analysis of the pseudo-synovial fluid obtained by aspiration. The diagnostic conclusions form the basis for considered treatment decisions.

scholarly journals Staphylococcus epidermidis isolates from nares and prosthetic joint infections are mupirocin susceptible

2018 ◽  
Vol 3 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Lavin Salih ◽  
Staffan Tevell ◽  
Emeli Månsson ◽  
Åsa Nilsdotter-Augustinsson ◽  
Bengt Hellmark ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Staphylococcus Epidermidis ◽  
Antimicrobial Agents ◽  
Multi Drug Resistance ◽  
Disc Diffusion ◽  
Diffusion Test ◽  
Joint Replacements ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Abstract. The objective of the present study was to investigate the antibiotic susceptibility including mupirocin among Staphylococcus. epidermidis isolated from prosthetic joint infections (PJIs) (n=183) and nasal isolates (n=75) from patients intended to undergo prosthetic joint replacements. Susceptibility to mupirocin (used for eradication of nasal carriership of Staphylococcus aureus) was investigated by gradient test, and susceptibility to various other antimicrobial agents was investigated by disc diffusion test. All isolates, except three from PJIs and one from the nares, were fully susceptible to mupirocin. Multi-drug resistance (≥3 antibiotic classes) was found in 154/183 (84.2%) of the PJI isolates but only in 2/75 (2.7%) of the nares isolates, indicating that S. epidermidis causing PJIs do not originate from the nares.

scholarly journals Use of Antibiotic Prophylaxis for Tooth Extractions, Dental Implants, and Periodontal Surgical Procedures

2017 ◽  
Vol 5 (1) ◽  
Author(s):  
Katie J Suda ◽  
Heather Henschel ◽  
Ursula Patel ◽  
Margaret A Fitzpatrick ◽  
Charlesnika T Evans
Keyword(s):  
Antibiotic Prophylaxis ◽  
Dental Implants ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Oral Infections ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Dental Procedures ◽  
Prosthetic Joint Infections ◽  
Tooth Extractions

Abstract Background Guidelines for antibiotics prior to dental procedures for patients with specific cardiac conditions and prosthetic joints have changed, reducing indications for antibiotic prophylaxis. In addition to guidelines focused on patient comorbidities, systematic reviews specific to dental extractions and implants support preprocedure antibiotics for all patients. However, data on dentist adherence to these recommendations are scarce. Methods This was a cross-sectional study of veterans undergoing tooth extractions, dental implants, and periodontal procedures. Patients receiving antibiotics for oral or nonoral infections were excluded. Data were collected through manual review of the health record. Results Of 183 veterans (mean age, 62 years; 94.5% male) undergoing the included procedures, 82.5% received antibiotic prophylaxis (mean duration, 7.1 ± 1.6 days). Amoxicillin (71.3% of antibiotics) and clindamycin (23.8%) were prescribed most frequently; 44.7% of patients prescribed clindamycin were not labeled as penicillin allergic. Of those who received prophylaxis, 92.1% received postprocedure antibiotics only, 2.6% received preprocedural antibiotics only, and 5.3% received pre- and postprocedure antibiotics. When prophylaxis was indicated, 87.3% of patients received an antibiotic. However, 84.9% received postprocedure antibiotics when preprocedure administration was indicated. While the majority of antibiotics were indicated, only 8.2% of patients received antibiotics appropriately. The primary reason was secondary to prolonged duration. Three months postprocedure, there were no occurrences of Clostridium difficile infection, infective endocarditis, prosthetic joint infections, or postprocedure oral infections. Conclusion The majority of patients undergoing a dental procedure received antibiotic prophylaxis as indicated. Although patients for whom antibiotic prophylaxis was indicated should have received a single preprocedure dose, most antibiotics were prescribed postprocedure. Dental stewardship efforts should ensure appropriate antibiotic timing, indication, and duration.

scholarly journals Microbiological Aetiology, Epidemiology, and Clinical Profile of Prosthetic Joint Infections: Are Current Antibiotic Prophylaxis Guidelines Effective?

2012 ◽  
Vol 56 (5) ◽  
pp. 2386-2391 ◽  
Author(s):  
Trisha N. Peel ◽  
Allen C. Cheng ◽  
Kirsty L. Buising ◽  
Peter F. M. Choong
Keyword(s):  
Antibiotic Prophylaxis ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Coagulase Negative Staphylococci ◽  
Methicillin Resistant ◽  
Content Type ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Surgical Antibiotic Prophylaxis

ABSTRACTProsthetic joint infections remain a major complication of arthroplasty. At present, local and international guidelines recommend cefazolin as a surgical antibiotic prophylaxis at the time of arthroplasty. This retrospective cohort study conducted across 10 hospitals over a 3-year period (January 2006 to December 2008) investigated the epidemiology and microbiological etiology of prosthetic joint infections. There were 163 cases of prosthetic joint infection identified. From a review of the microbiological culture results, methicillin-resistantStaphylococcus aureus(MRSA) and coagulase-negative staphylococci were isolated in 45% of infections. In addition, polymicrobial infections, particularly those involving Gram-negative bacilli and enterococcal species, were common (36%). The majority (88%) of patients received cefazolin as an antibiotic prophylaxis at the time of arthroplasty. In 63% of patients in this cohort, the microorganisms subsequently obtained were not susceptible to the antibiotic prophylaxis administered. The results of this study highlight the importance of ongoing reviews of the local ecology of prosthetic joint infection, demonstrating that the spectrum of pathogens involved is broad. The results should inform empirical antibiotic therapy. This report also provokes discussion about infection control strategies, including changing surgical antibiotic prophylaxis to a combination of glycopeptide and cefazolin, to reduce the incidence of infections due to methicillin-resistant staphylococci.

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

2017 ◽  
Vol 18 (7) ◽  
pp. 559-566 ◽  
Author(s):  
Francisco Rivera-Hidalgo ◽  
Leah S Spittle ◽  
Kathleen B Muzzin ◽  
Patricia R Campbell ◽  
Janice P DeWald
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Prophylaxis ◽  
Joint Replacement ◽  
Heart Association ◽  
The United States ◽  
Prescribing Practices ◽  
Joint Replacements ◽  
South Central ◽  
Prosthetic Joint ◽  
Dental Practitioners

ABSTRACT Aim Antibiotic prophylaxis guidelines have been developed for health care and dentistry. The authors examined whether dentists were following the 2007 American Heart Association (AHA) and the 2012 American Association of Orthopaedic Surgeons (AAOS) recommendations for antibiotic prophylaxis. Materials and methods A survey was sent to 600 dentists in the south-central region of the United States. The survey examined dentists’ prescribing practices for patients with cardiac and prosthetic joint replacements, antibiotic regimen prescribed, confidence in their prescription decisions, and dentistry's contribution to antibiotic resistance. Results The response rate was 28.7% (n = 172). Dentists followed the 2007 AHA guidelines for patients with a history of infective endocarditis (95%), and cardiac valves repaired with prosthetic materials (76%) or animal/donor tissue (61%). For prosthetic joint replacement, 72% prescribed antibiotic prophylaxis within the first 2 years after placement and 58% continued to prescribe after 2 years. Amoxicillin was the most frequently prescribed antibiotic for cardiac conditions (92%) and prosthetic joint replacements (77%). No significant differences were found in relation to dentists’ gender (p = 0.75), year of graduation (p = 0.71), scope of practice (p = 0.30), and their confidence in their prescription decisions; 73% believed taking multiple doses of antibiotics leads to antibiotic resistance. Conclusion The majority of dentists were following the 2007 AHA guidelines. Confusion regarding the 2012 AAOS guidelines for prosthetic joint replacement was evident. Clinical significance Keeping current with changing antibiotic prophylaxis guidelines ensures dentists are providing the best evidence-based dentistry for their patients. How to cite this article Spittle LS, Muzzin KB, Campbell PR, DeWald JP, Rivera-Hidalgo F. Current prescribing Practices for Antibiotic Prophylaxis: A Survey of Dental Practitioners. J Contemp Dent Pract 2017;18(7):559-566.

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