Evidence Insufficient To Recommend Routine Antibiotics
For Joint Replacement Patients Who Undergo Dental Procedures
27 Dec
2012
The American
Academy of Orthopaedic Surgeons(AAOS), and the American Dental Association(ADA)
found that there is insufficient evidence to recommend the routine use of
antibiotics for patients with orthopaedic implants to prevent infections prior
to having dental procedures because there is no direct evidence that routine
dental procedures cause prosthetic joint infections.
The AAOS and ADA's
recommendations are based on a collaborative evidence-based clinical practice
guideline that focuses on the possible linkage between orthopaedic implant
infection and patients undergoing dental procedures.
"As
clinicians, we want what is in the best interest of our patients, so this
clinical practice guideline is not meant to be a stand-alone document. Instead
it should be used as an educational tool to guide clinicians through treatment
decisions with their patients in an effort to improve quality and effectiveness
of care," said David Jevsevar, MD, MBA, chair of the AAOS Evidence Based
Practice Committee which oversees the development of clinical practice
guidelines.
"It has been
long debated that patients with orthopaedic implants, primarily hip and knee
replacements, are prone to implant infections from routine dental
procedures," added Dr. Jevsevar who also is an orthopaedic surgeon in St.
George, Utah. "What we found in this analysis is that there is no
conclusive evidence that demonstrates a need to routinely administer
antibiotics to patients with an orthopaedic implant, who undergo dental
procedures.
In 2010, there were
more than 302,000 hip replacement and 658,000 knee replacement procedures
performed in the United States.1
Infections can
occur when foreign organisms enter the wound during or at any point following
joint replacement, and can lead to additional surgery and prolonged antibiotic
treatment.2 For studies of hip and knee included in this guideline, the mean
rate of infection was 2 percent.3
Elliot Abt, DDS,
MS, MSc, who served as member of the AAOS-ADA work group on behalf of the ADA,
pointed out that the review committee conducted a thorough review of existing
clinical research published in the peer-reviewed literature.
"This
guideline was based primarily on clinical research which examined a large group
of patients, all having a prosthetic hip or knee and half with an infected
prosthetic joint," said Dr. Abt, a general dentist in Skokie, Ill., and a
member of the ADA Council on Scientific Affairs. "The research showed that
invasive dental procedures, with or without antibiotics, did not increase the
odds of developing a prosthetic joint infection."
This clinical
practice guideline, with three recommendations, is based on a systematic review
of the correlation between dental procedures and prosthetic joint infection
(PJI).
Recommendation one,
which is based on limited evidence, supports that practitioners consider
changing their longstanding practice of prescribing prophylactic antibiotics
for patients who undergo dental procedures. Limited evidence shows that dental
procedures are unrelated to PJI.
Recommendation two
addresses the use of oral topical antimicrobials (topical antibiotic
administered by a dentist) in the prevention of PJI in patients undergoing
dental procedures. There is no direct evidence that the use of oral topical
antimicrobials before dental procedures will prevent PJI.
Recommendation
three is the only consensus recommendation in the guideline, and it supports
the maintenance of good oral hygiene.
"Research is
always changing and we need to work to improve clinical research databases, so
in the future any type of prospective research done in this area will help shed
light on prophylaxis and orthopaedic infection rates," Dr. Jevsevar said.
The
"Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental
Procedures" guideline replaces the previous AAOS Information Statement,
"Antibiotic Prophylaxis for Bacteremia in Patients with Joint
Replacement." The full guideline along with all supporting documentation
and workgroup disclosures is available on the AAOS website
and the ADA website.
References:
1 HCUPnet.
Healthcare Cost and Utilization Project (HCUP). 1993-2010. Agency for
Healthcare Research and Quality, Rockville, MD. http://hcupnet.ahrq.gov/
Accessed November 29, 2012.
2 Della Valle CJ,
Zuckerman JD, Di Cesare PE. Periprosthetic Sepsis. Clin Orthop
2004;(420):26-31.
3 American Academy
of Orthopaedic Surgeons and the American Dental Association Prevention of
Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
Guideline. Rosemont (IL): AAOS: 2012.
More about AAOS
Evidence-based Clinical Practice Guidelines
This guideline is
an educational tool to guide clinicians through treatment decisions in an
effort to improve the quality and effectiveness of care. This guideline should
not be construed as including all methods of care or excluding methods of care
reasonably directed to obtaining the same results. The decision regarding any
specific procedure or treatment must be made in light of all circumstances
presented by the patient, the needs and resources particular to the locality or
institution, and the clinical judgment of the provider.
Citations:
Please use one of the
following formats to cite this article in your essay, paper or report:
MLA
American Academy of Orthopaedic Surgeons. "Evidence Insufficient To
Recommend Routine Antibiotics For Joint Replacement Patients Who Undergo Dental
Procedures." Medical News Today. MediLexicon, Intl., 27 Dec. 2012.
Web.
4 Jan. 2013. <http://www.medicalnewstoday.com/releases/254271.php>
APA
American Academy of Orthopaedic Surgeons. (2012, December 27).
"Evidence Insufficient To Recommend Routine Antibiotics For Joint
Replacement Patients Who Undergo Dental Procedures." Medical News Today.
Retrieved from
Please note: If no
author information is provided, the source is cited instead.
Any medical
information published on this website is not intended as a substitute for
informed medical advice and you should not take any action before consulting
with a health care professional. For more information, please read our terms and conditions.
Weekly newsletter
e-mails available at: http://www.medicalnewstoday.com/newsletters.php
Send your press releases to pressrelease@medicalnewstoday.com
No comments:
Post a Comment