Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-11-22, 09:52:12 | version 1.38.0
| CE article antibiotics 14 roots 4 2016 Antibiotic prophylaxis for prevention of delayed prosthetic joint infection In 1997, the ADA and the American Academy of Orthopedic Surgeons convened an expert panel of dentists,orthopedicsurgeonsandinfectiousdisease specialists and published an Advisory Statementon AntibioticProphylaxisfordentalpatientswithpros- thetic joints.18 A 2003 advisory statement included some modifications of the classification of patients at potential risk and the stratification of bacteremic dentalprocedures(Table4),butnochangesinterms of suggested antibiotics or antibiotic regimens.19 Antibiotic prophylaxis is not indicated for most dental patients with total joint replacements or for patients with pins, plates or screws. However, it is advised to consider antibiotic premedication in a small number of patients who may be at potential increased risk of experiencing hematogenous total joint infection (Table 5). While bacteremias can cause hematogenous seeding of total joint implants, it is likely that more oralbacteremiasarespontaneouslyinducedbyrou- tine daily events than are dental treatment-induced. Patients who have undergone total joint arthro- plasty should be encouraged to perform effective daily oral hygiene procedures in order to maintain good oral health. The risk of bacteremia is much higher in a mouth with chronic inflammation than one that is healthy and well maintained. Occasionally, a patient with a total joint prosthe- sis may present for dental treatment with a recom- mendation from his or her physician that is incon- sistent with the current guidelines. In this case, the dentist is encouraged to consult with the patient’s physician to discuss the nature of the needed den- tal treatment, to review the current guidelines re- garding antibiotic prophylaxis and to determine if there are any special considerations that might af- fect the physician’s decision regarding antibiotic prophylaxis for the patient. After this consultation, thedentistmaydecidetofollowthephysician’srec- ommendation or, if in his or her professional judg- ment antibiotic prophylaxis is not indicated, decide to proceed with the needed dental treatment with- out antibiotic prophylaxis. The dentist is ultimately responsible for making treatment decisions for his or her patient based on the dentist’s professional judgment. In February 2009, the AAOS published an infor- mation statement in which the organization, “rec- ommends that clinicians consider antibiotic pro- phylaxisforalltotaljointreplacementpatientsprior to any invasive procedure that may cause bactere- mia.”20 In response to this statement, the American Academy of Oral Medicine published a position pa- per in the June 2010 edition of the Journal of the American Dental Association.21 The authors of the AAOM position paper stated hat they reviewed the available literature on the subject as it relates to the AAOS 2009 information statement and concluded: “The risk of patients’ ex- periencing drug reactions or drug-resistant bacte- rialinfectionsandthecostofantibioticmedications alone do not justify the practice of using antibiotic prophylaxis in (all) patients with prosthetic joints.” The authors called for a future multidisciplinary, systematic review of the literature relating to anti- biotic prophylaxis use in patients with prosthetic joints. In the meantime, they concluded that the new AAOS 2009 information statement20 should not replace the 2003 joint consensus statement.19 InDecember2012,apanelofexpertsrepresenting the American Academy of Orthopedic Surgeons and the American Dental Association published a systematic review and clinical practice guideline, titled “Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures: Evidence based Guideline and Evidence Report.”23 This report contained the following three recommendations: “The practitioner might consider discontinuing the practice of routinely prescribing prophylactic antibioticsforpatientswithhipandkneeprosthetic joint implants undergoing dental procedures. “We are unable to recommend for or against the use of topical oral antimicrobials in patients with Patients at Potential Risk of Experiencing Hematogenous Total Joint Infection19 PatientType Condition Placing Patient at Risk All patients during first two years following joint replacement N/A Immunocompromised/ immunosuppressed patients Inflammatory arthropathies such as rheumatoid arthritis,systemic lupus erythematosus Drug or radiation-induced immunosup- pression Patients with comorbidities (Conditions listed for patients in this category are examples only; there may be additional conditions that place such patients at risk of experiencing hemato genous total joint infection) Malnourishment Hemophilia HIV infection Insulin-dependent (type 1) diabetes Malignancy Table 4 42016