Antibiotic prophylaxis to reduce the risk of joint implant contamination during dental surgery seems unnecessary - 06/12/12

Doi : 10.1016/j.otsr.2012.07.013

L. Legout ^a,^b,^⁎,^c , E. Beltrand ^c,^d, H. Migaud ^a,^c,^e, E. Senneville ^a,^b,^c
^a Lille Nord-de-France University, 59000 Lille, France
^b University Infectious Diseases and Travelers Department, Dron Hospital, rue du Président-Coty, 59208 Tourcoing, rue du Président-Coty, 59208 Tourcoing, France
^c G4 Lille-Tourcoing Osteo-articular Infection Reference Center, Salengro Hospital, Lille Regional University Hospital Center, rue Émile-Laine, 59037 Lille, France
^d Orthopedics-Traumatology Department, Dron Hospital, rue du Président-Coty, 59208 Tourcoing, France
^e University Orthopedics and Traumatology Department Salengro Hospital, Lille Regional University Hospital Center, rue Émile-Laine, 59037 Lille, France

Corresponding author. Tel.: +33 32 069 4591; fax: +33 32 069 4496. Service de Médecine, Hôpital Dron, 135, rue President-Coty, Tourcoing, France.

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Summary

Introduction

Joint implant infection rates range between 0.5% and 3%. Contamination may be hematogenous, originating in oro-dental infection and, as in endocarditis, antibiotic prophylaxis has been recommended to cover oro-dental surgery in immunodepressed patients with joint implants less than 2years old, despite the lack of any formal proof of efficacy. In this context, the cost and side effects of such prophylaxis raise the question of its real utility.

Materials and methods

A search of Pubmed was performed using the following keywords: prosthetic joint infection, dental procedure, antibiotic prophylaxis, hematogenous infection, dental infection, bacteremia, and endocarditis. Six hundred and fifty articles were retrieved, 68 of which were analyzed in terms of orthopedic prosthetic infection and/or endocarditis and oro-dental prophylaxis, as relevant to the following questions: frequency and intensity of bacteremia of oro-dental origin, frequency of prosthetic joint infection secondary to dental surgery, and objective efficacy of antibiotic prophylaxis in dental surgery in patients with joint implants.

Results

Bacteremia of oro-dental origin is more frequently associated with everyday activities such as mastication than with tooth extraction. Isolated cases of prosthetic contamination from dental infection have been reported, but epidemiological studies in joint implant bearers found that absence of antibiotic prophylaxis during oro-dental surgery did not increase the rate of prosthetic infection. The analysis was not able to answer the question of the efficacy of dental antibiotic prophylaxis in immunodepressed patients; however, oro-dental hygiene and regular dental treatment reduce the risk of prosthetic infection by 30%.

Discussion and conclusion

The present update is in agreement with the conclusions of ANSM expert group, which advised against antibiotic prophylaxis in oro-dental surgery in implant bearers, regardless of implant duration or comorbidity: the associated costs and risks are disproportional to efficacy.