- Email: [email protected]
Antibiotic prophylaxis to reduce the risk of joint implant contamination during dental surgery seems unnecessary
Orthopaedics & Traumatology: Surgery & Research (2012) 98, 910—914
Available online at
www.sciencedirect.com
REVIEW ARTICLE
Antibiotic prophylaxis to reduce the risk of joint implant contamination during dental surgery seems unnecessary 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 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 b
Accepted: 11 July 2012
KEYWORDS Dental infection; Dental prophylaxis; Prosthetic joint infection; Amoxicillin; Total joint replacement
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 2 years 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
∗ Corresponding author. Tel.: +33 32 069 4591; fax: +33 32 069 4496. Service de Médecine, Hôpital Dron, 135, rue President-Coty, Tourcoing, France.
1877-0568/$ – see front matter © 2012 Published by Elsevier Masson SAS. doi:10.1016/j.otsr.2012.07.013
Antibiotic prophylaxis for joint implants in dental surgery
911
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. Level of evidence and type of study: Level V; expert opinion. © 2012 Published by Elsevier Masson SAS.
Introduction Osteo-articular prosthetic infection (OAPI) affects less than 1% of hip replacement bearers and 1% to 2% of knee replacement bearers. It is hematogenous in 30% of cases, usually with a urinary or cutaneous origin [1—5]. There have been reports of OAPI following dental surgery, with a suggested causal relationship [6—16]. In certain at-risk situations, antibiotic prophylaxis covering dental treatment may thus seem indicated to prevent hematogenous prosthetic contamination. In France, amoxicillin is recommended in this context in case of implants less than 2 years old, especially in immunodepressed patients [17—24]. No studies, however, have demonstrated the interest of such prophylaxis, while costs are high and there is a risk of selecting resistant bacteria. For these reasons, antibiotic prophylaxis is no longer applied, for example, in cardiology; there has been no consequent increase in the incidence of endocarditis [25—27]. It therefore seemed logical to extend the same attitude to bearers of orthopedic implants, especially in the light of the latest AFSSAPS/ANSM (French health authorities) guidelines [28]. The present article provides an update on antibiotic prophylaxis in dental surgery in orthopedic implant bearers, focusing on three points: • the frequency and intensity of bacteremia of oro-dental origin; • the frequency of OAPI secondary to dental surgery; • and the objective efficacy of antibiotic prophylaxis in dental surgery in joint implant bearers.
Materials and methods A Pubmed search of English and French language articles was conducted using the following keywords: • ‘‘prosthetic joint infection’’ (1067 articles); • ‘‘prosthetic joint infection’’ and ‘‘dental procedure’’ (57 articles); • ‘‘prosthetic joint infection’’ and ‘‘antibiotic prophylaxis’’ (105 articles); • ‘‘dental procedure’’ and ‘‘hematogenous infection’’ (14 articles): • ‘‘dental infection’’ and ‘‘bacteremia’’ (646 articles); • ‘‘bacteremia’’ and ‘‘joint replacement’’ (64 articles);
• and ‘‘endocarditis’’ (1053 articles).
and
‘‘antibiotic
prophylaxis’’
Retrospective or prospective studies and case reports specifically focusing on orthopedic implant infection and/or endocarditis secondary to a dental procedure were shortlisted (650 articles), and analysis finally used articles addressing the following questions: frequency and intensity of bacteremia of oro-dental origin, frequency of OAPI secondary to dental surgery, and objective efficacy of antibiotic prophylaxis in dental surgery in patients with joint implants. On these criteria, the literature review comprised 68 of the 650 short-listed articles.
Results Frequency and intensity of bacteremia of oro-dental origin The incidence of bacteremia during tooth extraction is 100% [29—32]. Intensity peaks within the 30 seconds following extraction at a plateau of 10 to 20 minutes. For everyday activities such as tooth-brushing or mastication, incidence is lower (20% to 58% in tooth-brushing and 17% to 51% in chewing gum), but with longer duration, proportional to that of the activity [33]. Guntheroth [34] estimated the cumulative duration of bacteremia due to daily tooth-brushing and mastication in a subject with healthy teeth at 5370 minutes (3.7 days) per month, whereas tooth extraction led to low-intensity bacteremia of no more than 6 to 30 minutes: i.e., the risk of onset of bacteremia is 154,000-fold greater in everyday activities than in tooth extraction. This accounts for the much higher frequency of spontaneous bacteremia found in subjects with defective oral hygiene than following tooth extraction [8,35].
Does bacteremia really induce bacterial contamination of internal orthopedic implants? It is difficult to establish the similarity between the dental site bacteria and those of the secondary lesion. The published data are founded on a very approximate analogy between blood-culture isolates and bacteria known to belong to the oro-dental flora. Clinicians are usually faced with the situation of a patient with negative blood culture and OAPI implicating a micro-organism presumed to be of
912 oro-dental origin: e.g., Streptococcus sp. (mitis, salivarius, sanguinis, mutans, anginosus, etc.), which is the main bacterial species in oral flora, strictly anaerobic bacteria (Prevotella sp., Fusobacterium sp., Peptostreptococcus sp., etc.) or staphylococcus. Oro-dental flora varies with age, local pH, oro-dental hygiene, associated parodontopathy, tooth decay, saliva quality, etc. [36—44]. Fortunately, proliferation is limited by local defense systems, and the bacteria implicated in hematogenous OAPI are rarely (< 1%) of orodental origin but rather S. aureus or uro-digestive species (Eschericha coli, Proteus sp., Salmonella sp., Listeria, Streptococcus sp., etc.). Prosthetic contamination secondary to oro-dental surgery is very unusual, even in series without antibiotic prophylaxis [1—3,5—8,11,12,45—51]. Ainscow and Denham [5] reported a higher risk of hematogenous OAPI in case of skin lesion than of dental surgery. The causal relation between dental procedure duration and prosthetic infection is thus controversial. In a retrospective study of 2973 total hip replacements, LaPorte et al. [6] found 52 late infections, only three of which were associated with dental procedures (6%; 0.1% of hip implants); patients had received no antibiotic prophylaxis, and procedure time exceeded 45 min. In another series [7] of 3490 knee replacements, only seven of the 62 cases of infection observed (11%; 0.2% of knee implants) were related to dental procedures without antibiotic prophylaxis, of a mean 115 minutes duration (range, 75—205 minutes); five of the seven patients showed risk factors (diabetes, rheumatoid arthritis). Likewise, Ainscow and Denham [5], Skaar et al. [51] and Bauer et al. [52] found no correlation between absence of antibiotic prophylaxis and onset of prosthetic infection. Ainscow and Denham [5] prospectively followed up 1112 patients for 6 years after arthroplasty without antibiotic prophylaxis during dental care: 22 developed OAPI, including three hematogenous cases of cutaneous origin (varicose ulcer), while 224 had had tooth extractions without antibiotic prophylaxis, none of whom developed hematogenous infection [5]; this study involved limitations, inasmuch as OAPI risk factors were analyzed on a questionnaire sent to the patients, weakening the force of the conclusions. Skaar et al. [51] confirmed the findings in a smaller retrospective series.
Does antibiotic prophylaxis reduce the incidence of osteo-articular prosthetic infection Amoxicillin is the molecule most frequently employed in prevention; administered ahead of oro-dental surgery, it reduced but did not abolish the risk of bacteremia implicating streptococcus or anaerobic bacteria [53—60]. Hall et al. [53] studied the incidence of Streptococcus viridens bacteremia in patients receiving either placebo or 2 g i.v. penicillin or 3 g amoxicillin 1 hour before dental surgery; in blood culture performed before, during and 15 minutes after the procedure, rates of S. viridans bacteremia were comparable (95%, 90% and 85%, respectively). Lockhart et al. [54], in contrast, found a significantly reduced risk of bacteremia with amoxicillin (versus placebo: 84% versus 33%), administered both peroperatively (20% versus 6%) or after tooth extraction (76% versus 15%).
L. Legout et al. Finally, such antibiotic prophylaxis shows no impact on prosthetic infection rates. Recently, in the only prospective case-control study in the field, Berbari et al. [8] found OAPI risk (in hip and knee implants) to be the same in patients undergoing dental surgery [odds ratio (OR), 0.8; 95% confidence interval (95% CI) (0.4—1.6)] and in controls [OR, 0.6; 95% CI, (0.4—1.1)]. In the same study, antibiotic prophylaxis performed during tooth extraction failed to reduce OAPI risk (in hip and knee implants) [OR, 0.9; 95% CI, (0.5—1.6) versus OR, 1.2; 95% CI, (0.7—2.2) without prophylaxis]; likewise, in a subgroup with implants of less than 1 year of age, OAPI risk following dental surgery was unaffected by antibiotic prophylaxis [8]. Given its doubtful efficacy, amoxicillin or penicillin antibiotic prophylaxis should be reconsidered in terms of cost, side effects and risk of bacterium selection [61—67]. The costs of antibiotic prophylaxis are increasing with the increasing number of joint implant bearers. Jacobson et al. [62] calculated a very low overall risk of OAPI, at 29.3 per 106 dental visits (0.00293%), while the cost of antibiotics to prevent one case of infection directly related to a dental procedure was $480,000 per year in the USA in 1990, if the extra costs incurred by antibiotic-related complications are taken into account. Side effects are mainly digestive (10—60%), allergic (4%) or anaphylactic shock or death (one per million oral amoxicillin prescriptions and 15 per million i.v. penicillin prescriptions), although no such complications have been reported following dental surgery. Selection for resistance, finally, is a risk incurred by any excessive use of antibiotics, and should as such be taken into account. Limiting the use of certain antibiotics in Streptococcus pneumoniae infection has been shown to restore susceptibility to amoxicillin [68].
Discussion The present literature review found no proven efficacy of antibiotic prophylaxis covering oro-dental surgery in joint implant bearers. Most studies were retrospective or single case reports; the one prospective case-control study [8] pointed to non-efficacy; statistical power was lacking to assess efficacy in the immunodepression subgroup. Lack of information regarding type of dental procedure and protocol (duration, with or without antibiotics) and lack of long-term follow-up preclude any definite conclusion. Oro-dental hygiene would seem to be more important for the prevention of OAPI, significantly reducing the frequency of bacteremia. No precise guidelines, however, have as yet been laid down as to the optimal frequency of oro-dental check-ups; one per year would appear reasonable to ensure healthy teeth [8]. It is for these reasons that the AFSSAPS/ANSM in 2011 advised against antibiotic prophylaxis in oro-dental procedures in joint implant bearers, whatever the age of the implant, the patient’s health status or the type of procedure, putting the accent rather on the quality of oro-dental hygiene [28]. The members of the latest consensus conference on the management of OAPI came to no decision, but did advise treating any infection site before joint replacement,
Antibiotic prophylaxis for joint implants in dental surgery particularly in the case of possible dental infection sites (decay, parodontopathy and especially dental abscess, etc.) [69].
Conclusion In the absence of proven efficacy of antibiotic prophylaxis covering oro-dental surgery in joint implant bearers, regardless of immune status, and in the absence of any harmful effect of abstention, French experts have recommended ceasing such protocols in favor of guidelines for optimizing oro-dental hygiene.
Disclosure of interest The authors (Laurence Legout and Eric Beltrand) declare that they have no conflicts of interest concerning this article, except for Eric Senneville, who is a consultant for AFSSAPS/ANSM. Henri Migaud is an occasional consultant in research and education for Zimmer and Tornier, receiving royalties from Tornier. Eric Senneville is a speaker for Novartis, Sanofi-Aventis, and receives congress support from Pfizer, MSD.
References [1] Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med 2004;351:1645—54. [2] Zimmerli W. Prosthetic joint infection: diagnosis and treatment. Curr Infect Dis Rep 2000;2:377—9. [3] Sendi P, Banderet F, Graber P, Zimmerli W. Periprosthetic joint infection following Staphylococcus aureus bacteremia. J Infect 2011;63:17—22. [4] Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis 1997;56:470—5. [5] Ainscow DA, Denham RA. The risk of haematogenous infection in total joint replacements. J Bone Joint Surg Br 1984;66:580—2. [6] LaPorte DM, Waldman BJ, Mont MA, Hungerford DS. Infections associated with dental procedures in total hip arthroplasty. J Bone Joint Surg Br 1999;81:56—9. [7] Waldman BJ, Mont MA, Hungerford DS. Total knee arthroplasty infections associated with dental procedures. Clin Orthop Relat Res 1997;343:164—72. [8] Berbari EF, Osmon DR, Carr A, et al. Dental procedures as risk factors for prosthetic hip or knee infection: a hospital-based prospective case-control study. Clin Infect Dis 2010;1(50):8—16. [9] Faden HS. Letter: dental procedures and bacteremia. Ann Intern Med 1974;81:274. [10] Young JL, May MM, Haddad SL. Infected total ankle arthroplasty following routine dental procedure. Foot Ankle Int 2009;30:252—7. [11] Sullivan PM, Johnston RC, Kelley SS. Late infection after total hip replacement, caused by an oral organism after dental manipulation. A case report. J Bone Joint Surg Am 1990;72:121—3. [12] Michels F, Colaert J, Gheysen F, Scheerlinck T. Late prosthetic joint infection due to Rothia mucilaginosa. Acta Orthop Belg 2007;73:263—7.
913 [13] Steingruber I, Bach CM, Czermak B, Nogler M, Wimmer C. Infection of a total hip arthroplasty with Prevotella loeschii. Clin Orthop Relat Res 2004;418:222—4. [14] Medina-Gens L, Bordes-Benitez A, Saez-Nieto JA, Pena-Lopez MJ. Infection of a total hip arthroplasty due to Gemella morbillorum. Enferm Infecc Microbiol Clin 2007;25:553. [15] Jellicoe PA, Cohen A, Campbell P. Haemophilus parainfluenzae complicating total hip arthroplasty: a rapid failure. J Arthroplasty 2002;17:114—6. [16] Rubin R, Salvati EA, Lewis R. Infected total hip replacement after dental procedures. Oral Surg Oral Med Oral Pathol 1976;41:18—23. [17] Shay K. Infectious complications of dental and periodontal diseases in the elderly population. Clin Infect Dis 2002;34:1215—23. [18] Rossi M, Zimmerli W, Furrer H, Zanetti G, Muhlemann K, Tauber MG. Antibiotic prophylaxis for late blood-borne infections of joint prostheses. Schweiz Monatsschr Zahnmed 2005;115:571—9. [19] Seymour RA, Whitworth JM, Martin M. Antibiotic prophylaxis for patients with joint prostheses - still a dilemma for dental practitioners. Br Dent J 2003;194:649—53. [20] Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc 2003; 134:895-899. [21] Uckay I, Hoffmeyer P, Trampuz A, et al. Antibiotic prophylaxis before dental procedures in arthroplasty patients. Rev Med Suisse 2010;6:727—30. [22] American Dental Association, American Academy of Orthopaedic Surgeons. Advisory statement. Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc 1997;128:1004—8. [23] Blackburn Jr WD, Alarcon GS. Prosthetic joint infections. A role for prophylaxis. Arthritis Rheum 1991;34(1):110—7. [24] Maderazo EG, Judson S, Pasternak H. Late infections of total joint prostheses. A review and recommendations for prevention. Clin Orthop Relat Res 1988;229:131—42. [25] Habib G. Infective endocarditis: what’s new? European Society of Cardiology (ESC) Guidelines 2009 on the prevention, diagnosis and treatment of infective endocarditis. Presse Med 2010;39:704—9. [26] Duval X, Gallien S, Leport C. What is the state of infective endocarditis prophylaxis guidelines according to the latest American recommendations? Med Mal Infect 2008;38(Suppl. 2):S52—4. [27] Allen U. Infective endocarditis: updated guidelines. Paediatr Child Health 2010;15:205—12. [28] Recommandations de prescription des antibiotiques en pratique buccodentaire. ANSM 2011. http://ansm.sante.fr/ content/download/5297/52416/version/12/file/RecoPrescription-des-antibiotiques-en-pratiquebuccodentaire Septembre2011.pdf [29] Moaref A, Shahrzad S, Aslani A. Acquired aortoventricular tunnel: a rare complication of infective endocarditis. Echocardiography 2009;26:82—3. [30] Vergis EN, Demas PN, Vaccarello SJ, Yu VL. Topical antibiotic prophylaxis for bacteremia after dental extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:162—5. [31] Sonbol H, Spratt D, Roberts GJ, Lucas VS. Prevalence, intensity and identity of bacteraemia following conservative dental procedures in children. Oral Microbiol Immunol 2009;24:177—82. [32] Heimdahl A, Hall G, Hedberg M, et al. Detection and quantitation by lysis-filtration of bacteremia after different oral surgical procedures. J Clin Microbiol 1990;28:2205—9. [33] Forner L, Larsen T, Kilian M, Holmstrup P. Incidence of bacteremia after chewing, tooth brushing and scaling in individuals with periodontal inflammation. J Clin Periodontol 2006;33:401—7. [34] Guntheroth WG. How important are dental procedures as a cause of infective endocarditis? Am J Cardiol 1984;54:797—801.
914 [35] Brennan MT, Kent ML, Fox PC, Norton HJ, Lockhart PB. The impact of oral disease and nonsurgical treatment on bacteremia in children. J Am Dent Assoc 2007;138:80—5. [36] Tabasum ST, Nayak RP. Salivary blood group antigens and microbial flora. Int J Dent Hyg 2011;9:117—21. [37] Parisotto TM, Steiner-Oliveira C, Duque C, Peres RC, Rodrigues LK, Nobre-dos-Santos M. Relationship among microbiological composition and presence of dental plaque, sugar exposure, social factors and different stages of early childhood caries. Arch Oral Biol 2010;55:365—73. [38] Brito A, Escalona LA, Correnti M, Perrone M, Bravo IM, Tovar V. Periodontal conditions and distribution of Prevotella intermedia, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in HIV-infected patients undergoing anti-retroviral therapy and in an HIV-seronegative group of the Venezuelan population. Acta Odontol Latinoam 2008;21:89—96. [39] Surna A, Sakalauskiene J, Vitkauskiene A, Saferis V. Microbiological and biochemical characteristics of inflammatory tissues in the periodontium. Medicina (Kaunas) 2008;44:201—10. [40] Aimetti M, Romano F, Nessi F. Microbiologic analysis of periodontal pockets and carotid atheromatous plaques in advanced chronic periodontitis patients. J Periodontol 2007;78:1718—23. [41] Castro P, Tovar JA, Jaramillo L. Adhesion of Streptococcus mutans to salivary proteins in caries-free and caries-susceptible individuals. Acta Odontol Latinoam 2006;19:59—66. [42] Koga-Ito CY, Martins CA, Balducci I, Jorge AO. Correlation among mutans streptococci counts, dental caries, and IgA to Streptococcus mutans in saliva. Braz Oral Res 2004;18:350—5. [43] Zambon JJ, Kasprzak SA. The microbiology and histopathology of human root caries. Am J Dent 1995;8:323—8. [44] Stiebe B, Poethe I, Bernhardt H. The bacteriology of normal wound healing following tooth extraction with special reference to anaerobic microorganism diagnosis. Zahn Mund Kieferheilkd Zentralbl 1990;78:247—51. [45] Bartz H, Nonnenmacher C, Bollmann C, et al. Micromonas (Peptostreptococcus) micros: unusual case of prosthetic joint infection associated with dental procedures. Int J Med Microbiol 2005;294:465—70. [46] Rodgers J, Richards D. No evidence to link prosthetic joint infections with dental procedures. Evid Based Dent 2008;9:103—4. [47] Gomila-Sard B, Tellez-Castillo CJ, Sabater-Vidal S, MorenoMunoz R. Early prosthetic joint infection due to Streptococcus oralis. Enferm Infecc Microbiol Clin 2009;27:547—8. [48] Lindqvist C, Slatis P. Dental bacteremia–a neglected cause of arthroplasty infections? Three hip cases. Acta Orthop Scand 1985;56:506—8. [49] Friedlander AH. Oral cavity staphylococci are a potential source of prosthetic joint infection. Clin Infect Dis 2010;15(50):1682—3 [author reply 3]. [50] Bartzokas CA, Johnson R, Jane M, Martin MV, Pearce PK, Saw Y. Relation between mouth and haematogenous infection in total joint replacements. BMJ 1994;309:506—8. [51] Skaar DD, O’Connor H, Hodges JS, Michalowicz BS. Dental procedures and subsequent prosthetic joint infections: findings from the Medicare Current Beneficiary Survey. J Am Dent Assoc 2011;142:1343—51.
L. Legout et al. [52] Bauer T, Maman L, Matha C, Mamoudy P. Dental care and joint prostheses. Rev Chir Orthop 2007;93:607—18. [53] Hall G, Hedstrom SA, Heimdahl A, Nord CE. Prophylactic administration of penicillins for endocarditis does not reduce the incidence of postextraction bacteremia. Clin Infect Dis 1993;17:188—94. [54] Lockhart PB, Brennan MT, Kent ML, Norton HJ, Weinrib DA. Impact of amoxicillin prophylaxis on the incidence, nature, and duration of bacteremia in children after intubation and dental procedures. Circulation 2004;109:2878—84. [55] Lockhart PB, Durack DT. Oral microflora as a cause of endocarditis and other distant site infections. Infect Dis Clin North Am 1999;13:833—50 [vi]. [56] Lockhart PB. An analysis of bacteremias during dental extractions. A double-blind, placebo-controlled study of chlorhexidine. Arch Intern Med 1996;156:513—20. [57] Lockhart PB. The risk for endocarditis in dental practice. Periodontol 2000 2000;23:127—35. [58] Roberts GJ, Radford P, Holt R. Prophylaxis of dental bacteraemia with oral amoxicillin in children. Br Dent J 1987;162:179—82. [59] Shanson DC, Akash S, Harris M, Tadayon M. Erythromycin stearate, 1.5 g, for the oral prophylaxis of streptococcal bacteraemia in patients undergoing dental extraction: efficacy and tolerance. J Antimicrob Chemother 1985;15: 83—90. [60] Strom BL, Abrutyn E, Berlin JA, et al. Dental and cardiac risk factors for infective endocarditis. A population-based, casecontrol study. Ann Intern Med 1998;129:761—9. [61] Norden CW. Prevention of bone and joint infections. Am J Med 1985;78:229—32. [62] Jacobson JJ, Schweitzer S, DePorter DJ, Lee JJ. Antibiotic prophylaxis for dental patients with joint prostheses? A decision analysis. Int J Technol Assess Health Care 1990;6: 569—87. [63] Tsevat J, Durand-Zaleski I, Pauker SG. Cost-effectiveness of antibiotic prophylaxis for dental procedures in patients with artificial joints. Am J Public Health 1989;79:739—43. [64] Clemens JD, Ransohoff DF. A quantitative assessment of predental antibiotic prophylaxis for patients with mitral-valve prolapse. J Chronic Dis 1984;37:531—44. [65] Devereux RB, Frary CJ, Kramer-Fox R, Roberts RB, Ruchlin HS. Cost-effectiveness of infective endocarditis prophylaxis for mitral valve prolapse with or without a mitral regurgitant murmur. Am J Cardiol 1994;74:1024—9. [66] Duval X, Leport C. Prophylaxis of infective endocarditis: current tendencies, continuing controversies. Lancet Infect Dis 2008;8:225—32. [67] Gould IM, Buckingham JK. Cost effectiveness of prophylaxis in dental practice to prevent infective endocarditis. Br Heart J 1993;70:79—83. [68] Lynch 3rd JP, Zhanel GG. Streptococcus pneumoniae: epidemiology and risk factors, evolution of antimicrobial resistance, and impact of vaccines. Curr Opin Pulm Med 2010;16: 217—25. [69] Société de Pathologie Infectieuse de Langue francaise. Recommendations for bone and joint prosthetic device infections in clinical practice (prosthesis, implants, osteosynthesis). Med Mal Infect 2010;40:185—211.
Available online at
www.sciencedirect.com
REVIEW ARTICLE
Antibiotic prophylaxis to reduce the risk of joint implant contamination during dental surgery seems unnecessary 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 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 b
Accepted: 11 July 2012
KEYWORDS Dental infection; Dental prophylaxis; Prosthetic joint infection; Amoxicillin; Total joint replacement
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 2 years 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
∗ Corresponding author. Tel.: +33 32 069 4591; fax: +33 32 069 4496. Service de Médecine, Hôpital Dron, 135, rue President-Coty, Tourcoing, France.
1877-0568/$ – see front matter © 2012 Published by Elsevier Masson SAS. doi:10.1016/j.otsr.2012.07.013
Antibiotic prophylaxis for joint implants in dental surgery
911
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. Level of evidence and type of study: Level V; expert opinion. © 2012 Published by Elsevier Masson SAS.
Introduction Osteo-articular prosthetic infection (OAPI) affects less than 1% of hip replacement bearers and 1% to 2% of knee replacement bearers. It is hematogenous in 30% of cases, usually with a urinary or cutaneous origin [1—5]. There have been reports of OAPI following dental surgery, with a suggested causal relationship [6—16]. In certain at-risk situations, antibiotic prophylaxis covering dental treatment may thus seem indicated to prevent hematogenous prosthetic contamination. In France, amoxicillin is recommended in this context in case of implants less than 2 years old, especially in immunodepressed patients [17—24]. No studies, however, have demonstrated the interest of such prophylaxis, while costs are high and there is a risk of selecting resistant bacteria. For these reasons, antibiotic prophylaxis is no longer applied, for example, in cardiology; there has been no consequent increase in the incidence of endocarditis [25—27]. It therefore seemed logical to extend the same attitude to bearers of orthopedic implants, especially in the light of the latest AFSSAPS/ANSM (French health authorities) guidelines [28]. The present article provides an update on antibiotic prophylaxis in dental surgery in orthopedic implant bearers, focusing on three points: • the frequency and intensity of bacteremia of oro-dental origin; • the frequency of OAPI secondary to dental surgery; • and the objective efficacy of antibiotic prophylaxis in dental surgery in joint implant bearers.
Materials and methods A Pubmed search of English and French language articles was conducted using the following keywords: • ‘‘prosthetic joint infection’’ (1067 articles); • ‘‘prosthetic joint infection’’ and ‘‘dental procedure’’ (57 articles); • ‘‘prosthetic joint infection’’ and ‘‘antibiotic prophylaxis’’ (105 articles); • ‘‘dental procedure’’ and ‘‘hematogenous infection’’ (14 articles): • ‘‘dental infection’’ and ‘‘bacteremia’’ (646 articles); • ‘‘bacteremia’’ and ‘‘joint replacement’’ (64 articles);
• and ‘‘endocarditis’’ (1053 articles).
and
‘‘antibiotic
prophylaxis’’
Retrospective or prospective studies and case reports specifically focusing on orthopedic implant infection and/or endocarditis secondary to a dental procedure were shortlisted (650 articles), and analysis finally used articles addressing the following questions: frequency and intensity of bacteremia of oro-dental origin, frequency of OAPI secondary to dental surgery, and objective efficacy of antibiotic prophylaxis in dental surgery in patients with joint implants. On these criteria, the literature review comprised 68 of the 650 short-listed articles.
Results Frequency and intensity of bacteremia of oro-dental origin The incidence of bacteremia during tooth extraction is 100% [29—32]. Intensity peaks within the 30 seconds following extraction at a plateau of 10 to 20 minutes. For everyday activities such as tooth-brushing or mastication, incidence is lower (20% to 58% in tooth-brushing and 17% to 51% in chewing gum), but with longer duration, proportional to that of the activity [33]. Guntheroth [34] estimated the cumulative duration of bacteremia due to daily tooth-brushing and mastication in a subject with healthy teeth at 5370 minutes (3.7 days) per month, whereas tooth extraction led to low-intensity bacteremia of no more than 6 to 30 minutes: i.e., the risk of onset of bacteremia is 154,000-fold greater in everyday activities than in tooth extraction. This accounts for the much higher frequency of spontaneous bacteremia found in subjects with defective oral hygiene than following tooth extraction [8,35].
Does bacteremia really induce bacterial contamination of internal orthopedic implants? It is difficult to establish the similarity between the dental site bacteria and those of the secondary lesion. The published data are founded on a very approximate analogy between blood-culture isolates and bacteria known to belong to the oro-dental flora. Clinicians are usually faced with the situation of a patient with negative blood culture and OAPI implicating a micro-organism presumed to be of
912 oro-dental origin: e.g., Streptococcus sp. (mitis, salivarius, sanguinis, mutans, anginosus, etc.), which is the main bacterial species in oral flora, strictly anaerobic bacteria (Prevotella sp., Fusobacterium sp., Peptostreptococcus sp., etc.) or staphylococcus. Oro-dental flora varies with age, local pH, oro-dental hygiene, associated parodontopathy, tooth decay, saliva quality, etc. [36—44]. Fortunately, proliferation is limited by local defense systems, and the bacteria implicated in hematogenous OAPI are rarely (< 1%) of orodental origin but rather S. aureus or uro-digestive species (Eschericha coli, Proteus sp., Salmonella sp., Listeria, Streptococcus sp., etc.). Prosthetic contamination secondary to oro-dental surgery is very unusual, even in series without antibiotic prophylaxis [1—3,5—8,11,12,45—51]. Ainscow and Denham [5] reported a higher risk of hematogenous OAPI in case of skin lesion than of dental surgery. The causal relation between dental procedure duration and prosthetic infection is thus controversial. In a retrospective study of 2973 total hip replacements, LaPorte et al. [6] found 52 late infections, only three of which were associated with dental procedures (6%; 0.1% of hip implants); patients had received no antibiotic prophylaxis, and procedure time exceeded 45 min. In another series [7] of 3490 knee replacements, only seven of the 62 cases of infection observed (11%; 0.2% of knee implants) were related to dental procedures without antibiotic prophylaxis, of a mean 115 minutes duration (range, 75—205 minutes); five of the seven patients showed risk factors (diabetes, rheumatoid arthritis). Likewise, Ainscow and Denham [5], Skaar et al. [51] and Bauer et al. [52] found no correlation between absence of antibiotic prophylaxis and onset of prosthetic infection. Ainscow and Denham [5] prospectively followed up 1112 patients for 6 years after arthroplasty without antibiotic prophylaxis during dental care: 22 developed OAPI, including three hematogenous cases of cutaneous origin (varicose ulcer), while 224 had had tooth extractions without antibiotic prophylaxis, none of whom developed hematogenous infection [5]; this study involved limitations, inasmuch as OAPI risk factors were analyzed on a questionnaire sent to the patients, weakening the force of the conclusions. Skaar et al. [51] confirmed the findings in a smaller retrospective series.
Does antibiotic prophylaxis reduce the incidence of osteo-articular prosthetic infection Amoxicillin is the molecule most frequently employed in prevention; administered ahead of oro-dental surgery, it reduced but did not abolish the risk of bacteremia implicating streptococcus or anaerobic bacteria [53—60]. Hall et al. [53] studied the incidence of Streptococcus viridens bacteremia in patients receiving either placebo or 2 g i.v. penicillin or 3 g amoxicillin 1 hour before dental surgery; in blood culture performed before, during and 15 minutes after the procedure, rates of S. viridans bacteremia were comparable (95%, 90% and 85%, respectively). Lockhart et al. [54], in contrast, found a significantly reduced risk of bacteremia with amoxicillin (versus placebo: 84% versus 33%), administered both peroperatively (20% versus 6%) or after tooth extraction (76% versus 15%).
L. Legout et al. Finally, such antibiotic prophylaxis shows no impact on prosthetic infection rates. Recently, in the only prospective case-control study in the field, Berbari et al. [8] found OAPI risk (in hip and knee implants) to be the same in patients undergoing dental surgery [odds ratio (OR), 0.8; 95% confidence interval (95% CI) (0.4—1.6)] and in controls [OR, 0.6; 95% CI, (0.4—1.1)]. In the same study, antibiotic prophylaxis performed during tooth extraction failed to reduce OAPI risk (in hip and knee implants) [OR, 0.9; 95% CI, (0.5—1.6) versus OR, 1.2; 95% CI, (0.7—2.2) without prophylaxis]; likewise, in a subgroup with implants of less than 1 year of age, OAPI risk following dental surgery was unaffected by antibiotic prophylaxis [8]. Given its doubtful efficacy, amoxicillin or penicillin antibiotic prophylaxis should be reconsidered in terms of cost, side effects and risk of bacterium selection [61—67]. The costs of antibiotic prophylaxis are increasing with the increasing number of joint implant bearers. Jacobson et al. [62] calculated a very low overall risk of OAPI, at 29.3 per 106 dental visits (0.00293%), while the cost of antibiotics to prevent one case of infection directly related to a dental procedure was $480,000 per year in the USA in 1990, if the extra costs incurred by antibiotic-related complications are taken into account. Side effects are mainly digestive (10—60%), allergic (4%) or anaphylactic shock or death (one per million oral amoxicillin prescriptions and 15 per million i.v. penicillin prescriptions), although no such complications have been reported following dental surgery. Selection for resistance, finally, is a risk incurred by any excessive use of antibiotics, and should as such be taken into account. Limiting the use of certain antibiotics in Streptococcus pneumoniae infection has been shown to restore susceptibility to amoxicillin [68].
Discussion The present literature review found no proven efficacy of antibiotic prophylaxis covering oro-dental surgery in joint implant bearers. Most studies were retrospective or single case reports; the one prospective case-control study [8] pointed to non-efficacy; statistical power was lacking to assess efficacy in the immunodepression subgroup. Lack of information regarding type of dental procedure and protocol (duration, with or without antibiotics) and lack of long-term follow-up preclude any definite conclusion. Oro-dental hygiene would seem to be more important for the prevention of OAPI, significantly reducing the frequency of bacteremia. No precise guidelines, however, have as yet been laid down as to the optimal frequency of oro-dental check-ups; one per year would appear reasonable to ensure healthy teeth [8]. It is for these reasons that the AFSSAPS/ANSM in 2011 advised against antibiotic prophylaxis in oro-dental procedures in joint implant bearers, whatever the age of the implant, the patient’s health status or the type of procedure, putting the accent rather on the quality of oro-dental hygiene [28]. The members of the latest consensus conference on the management of OAPI came to no decision, but did advise treating any infection site before joint replacement,
Antibiotic prophylaxis for joint implants in dental surgery particularly in the case of possible dental infection sites (decay, parodontopathy and especially dental abscess, etc.) [69].
Conclusion In the absence of proven efficacy of antibiotic prophylaxis covering oro-dental surgery in joint implant bearers, regardless of immune status, and in the absence of any harmful effect of abstention, French experts have recommended ceasing such protocols in favor of guidelines for optimizing oro-dental hygiene.
Disclosure of interest The authors (Laurence Legout and Eric Beltrand) declare that they have no conflicts of interest concerning this article, except for Eric Senneville, who is a consultant for AFSSAPS/ANSM. Henri Migaud is an occasional consultant in research and education for Zimmer and Tornier, receiving royalties from Tornier. Eric Senneville is a speaker for Novartis, Sanofi-Aventis, and receives congress support from Pfizer, MSD.
References [1] Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med 2004;351:1645—54. [2] Zimmerli W. Prosthetic joint infection: diagnosis and treatment. Curr Infect Dis Rep 2000;2:377—9. [3] Sendi P, Banderet F, Graber P, Zimmerli W. Periprosthetic joint infection following Staphylococcus aureus bacteremia. J Infect 2011;63:17—22. [4] Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis 1997;56:470—5. [5] Ainscow DA, Denham RA. The risk of haematogenous infection in total joint replacements. J Bone Joint Surg Br 1984;66:580—2. [6] LaPorte DM, Waldman BJ, Mont MA, Hungerford DS. Infections associated with dental procedures in total hip arthroplasty. J Bone Joint Surg Br 1999;81:56—9. [7] Waldman BJ, Mont MA, Hungerford DS. Total knee arthroplasty infections associated with dental procedures. Clin Orthop Relat Res 1997;343:164—72. [8] Berbari EF, Osmon DR, Carr A, et al. Dental procedures as risk factors for prosthetic hip or knee infection: a hospital-based prospective case-control study. Clin Infect Dis 2010;1(50):8—16. [9] Faden HS. Letter: dental procedures and bacteremia. Ann Intern Med 1974;81:274. [10] Young JL, May MM, Haddad SL. Infected total ankle arthroplasty following routine dental procedure. Foot Ankle Int 2009;30:252—7. [11] Sullivan PM, Johnston RC, Kelley SS. Late infection after total hip replacement, caused by an oral organism after dental manipulation. A case report. J Bone Joint Surg Am 1990;72:121—3. [12] Michels F, Colaert J, Gheysen F, Scheerlinck T. Late prosthetic joint infection due to Rothia mucilaginosa. Acta Orthop Belg 2007;73:263—7.
913 [13] Steingruber I, Bach CM, Czermak B, Nogler M, Wimmer C. Infection of a total hip arthroplasty with Prevotella loeschii. Clin Orthop Relat Res 2004;418:222—4. [14] Medina-Gens L, Bordes-Benitez A, Saez-Nieto JA, Pena-Lopez MJ. Infection of a total hip arthroplasty due to Gemella morbillorum. Enferm Infecc Microbiol Clin 2007;25:553. [15] Jellicoe PA, Cohen A, Campbell P. Haemophilus parainfluenzae complicating total hip arthroplasty: a rapid failure. J Arthroplasty 2002;17:114—6. [16] Rubin R, Salvati EA, Lewis R. Infected total hip replacement after dental procedures. Oral Surg Oral Med Oral Pathol 1976;41:18—23. [17] Shay K. Infectious complications of dental and periodontal diseases in the elderly population. Clin Infect Dis 2002;34:1215—23. [18] Rossi M, Zimmerli W, Furrer H, Zanetti G, Muhlemann K, Tauber MG. Antibiotic prophylaxis for late blood-borne infections of joint prostheses. Schweiz Monatsschr Zahnmed 2005;115:571—9. [19] Seymour RA, Whitworth JM, Martin M. Antibiotic prophylaxis for patients with joint prostheses - still a dilemma for dental practitioners. Br Dent J 2003;194:649—53. [20] Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc 2003; 134:895-899. [21] Uckay I, Hoffmeyer P, Trampuz A, et al. Antibiotic prophylaxis before dental procedures in arthroplasty patients. Rev Med Suisse 2010;6:727—30. [22] American Dental Association, American Academy of Orthopaedic Surgeons. Advisory statement. Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc 1997;128:1004—8. [23] Blackburn Jr WD, Alarcon GS. Prosthetic joint infections. A role for prophylaxis. Arthritis Rheum 1991;34(1):110—7. [24] Maderazo EG, Judson S, Pasternak H. Late infections of total joint prostheses. A review and recommendations for prevention. Clin Orthop Relat Res 1988;229:131—42. [25] Habib G. Infective endocarditis: what’s new? European Society of Cardiology (ESC) Guidelines 2009 on the prevention, diagnosis and treatment of infective endocarditis. Presse Med 2010;39:704—9. [26] Duval X, Gallien S, Leport C. What is the state of infective endocarditis prophylaxis guidelines according to the latest American recommendations? Med Mal Infect 2008;38(Suppl. 2):S52—4. [27] Allen U. Infective endocarditis: updated guidelines. Paediatr Child Health 2010;15:205—12. [28] Recommandations de prescription des antibiotiques en pratique buccodentaire. ANSM 2011. http://ansm.sante.fr/ content/download/5297/52416/version/12/file/RecoPrescription-des-antibiotiques-en-pratiquebuccodentaire Septembre2011.pdf [29] Moaref A, Shahrzad S, Aslani A. Acquired aortoventricular tunnel: a rare complication of infective endocarditis. Echocardiography 2009;26:82—3. [30] Vergis EN, Demas PN, Vaccarello SJ, Yu VL. Topical antibiotic prophylaxis for bacteremia after dental extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:162—5. [31] Sonbol H, Spratt D, Roberts GJ, Lucas VS. Prevalence, intensity and identity of bacteraemia following conservative dental procedures in children. Oral Microbiol Immunol 2009;24:177—82. [32] Heimdahl A, Hall G, Hedberg M, et al. Detection and quantitation by lysis-filtration of bacteremia after different oral surgical procedures. J Clin Microbiol 1990;28:2205—9. [33] Forner L, Larsen T, Kilian M, Holmstrup P. Incidence of bacteremia after chewing, tooth brushing and scaling in individuals with periodontal inflammation. J Clin Periodontol 2006;33:401—7. [34] Guntheroth WG. How important are dental procedures as a cause of infective endocarditis? Am J Cardiol 1984;54:797—801.
914 [35] Brennan MT, Kent ML, Fox PC, Norton HJ, Lockhart PB. The impact of oral disease and nonsurgical treatment on bacteremia in children. J Am Dent Assoc 2007;138:80—5. [36] Tabasum ST, Nayak RP. Salivary blood group antigens and microbial flora. Int J Dent Hyg 2011;9:117—21. [37] Parisotto TM, Steiner-Oliveira C, Duque C, Peres RC, Rodrigues LK, Nobre-dos-Santos M. Relationship among microbiological composition and presence of dental plaque, sugar exposure, social factors and different stages of early childhood caries. Arch Oral Biol 2010;55:365—73. [38] Brito A, Escalona LA, Correnti M, Perrone M, Bravo IM, Tovar V. Periodontal conditions and distribution of Prevotella intermedia, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in HIV-infected patients undergoing anti-retroviral therapy and in an HIV-seronegative group of the Venezuelan population. Acta Odontol Latinoam 2008;21:89—96. [39] Surna A, Sakalauskiene J, Vitkauskiene A, Saferis V. Microbiological and biochemical characteristics of inflammatory tissues in the periodontium. Medicina (Kaunas) 2008;44:201—10. [40] Aimetti M, Romano F, Nessi F. Microbiologic analysis of periodontal pockets and carotid atheromatous plaques in advanced chronic periodontitis patients. J Periodontol 2007;78:1718—23. [41] Castro P, Tovar JA, Jaramillo L. Adhesion of Streptococcus mutans to salivary proteins in caries-free and caries-susceptible individuals. Acta Odontol Latinoam 2006;19:59—66. [42] Koga-Ito CY, Martins CA, Balducci I, Jorge AO. Correlation among mutans streptococci counts, dental caries, and IgA to Streptococcus mutans in saliva. Braz Oral Res 2004;18:350—5. [43] Zambon JJ, Kasprzak SA. The microbiology and histopathology of human root caries. Am J Dent 1995;8:323—8. [44] Stiebe B, Poethe I, Bernhardt H. The bacteriology of normal wound healing following tooth extraction with special reference to anaerobic microorganism diagnosis. Zahn Mund Kieferheilkd Zentralbl 1990;78:247—51. [45] Bartz H, Nonnenmacher C, Bollmann C, et al. Micromonas (Peptostreptococcus) micros: unusual case of prosthetic joint infection associated with dental procedures. Int J Med Microbiol 2005;294:465—70. [46] Rodgers J, Richards D. No evidence to link prosthetic joint infections with dental procedures. Evid Based Dent 2008;9:103—4. [47] Gomila-Sard B, Tellez-Castillo CJ, Sabater-Vidal S, MorenoMunoz R. Early prosthetic joint infection due to Streptococcus oralis. Enferm Infecc Microbiol Clin 2009;27:547—8. [48] Lindqvist C, Slatis P. Dental bacteremia–a neglected cause of arthroplasty infections? Three hip cases. Acta Orthop Scand 1985;56:506—8. [49] Friedlander AH. Oral cavity staphylococci are a potential source of prosthetic joint infection. Clin Infect Dis 2010;15(50):1682—3 [author reply 3]. [50] Bartzokas CA, Johnson R, Jane M, Martin MV, Pearce PK, Saw Y. Relation between mouth and haematogenous infection in total joint replacements. BMJ 1994;309:506—8. [51] Skaar DD, O’Connor H, Hodges JS, Michalowicz BS. Dental procedures and subsequent prosthetic joint infections: findings from the Medicare Current Beneficiary Survey. J Am Dent Assoc 2011;142:1343—51.
L. Legout et al. [52] Bauer T, Maman L, Matha C, Mamoudy P. Dental care and joint prostheses. Rev Chir Orthop 2007;93:607—18. [53] Hall G, Hedstrom SA, Heimdahl A, Nord CE. Prophylactic administration of penicillins for endocarditis does not reduce the incidence of postextraction bacteremia. Clin Infect Dis 1993;17:188—94. [54] Lockhart PB, Brennan MT, Kent ML, Norton HJ, Weinrib DA. Impact of amoxicillin prophylaxis on the incidence, nature, and duration of bacteremia in children after intubation and dental procedures. Circulation 2004;109:2878—84. [55] Lockhart PB, Durack DT. Oral microflora as a cause of endocarditis and other distant site infections. Infect Dis Clin North Am 1999;13:833—50 [vi]. [56] Lockhart PB. An analysis of bacteremias during dental extractions. A double-blind, placebo-controlled study of chlorhexidine. Arch Intern Med 1996;156:513—20. [57] Lockhart PB. The risk for endocarditis in dental practice. Periodontol 2000 2000;23:127—35. [58] Roberts GJ, Radford P, Holt R. Prophylaxis of dental bacteraemia with oral amoxicillin in children. Br Dent J 1987;162:179—82. [59] Shanson DC, Akash S, Harris M, Tadayon M. Erythromycin stearate, 1.5 g, for the oral prophylaxis of streptococcal bacteraemia in patients undergoing dental extraction: efficacy and tolerance. J Antimicrob Chemother 1985;15: 83—90. [60] Strom BL, Abrutyn E, Berlin JA, et al. Dental and cardiac risk factors for infective endocarditis. A population-based, casecontrol study. Ann Intern Med 1998;129:761—9. [61] Norden CW. Prevention of bone and joint infections. Am J Med 1985;78:229—32. [62] Jacobson JJ, Schweitzer S, DePorter DJ, Lee JJ. Antibiotic prophylaxis for dental patients with joint prostheses? A decision analysis. Int J Technol Assess Health Care 1990;6: 569—87. [63] Tsevat J, Durand-Zaleski I, Pauker SG. Cost-effectiveness of antibiotic prophylaxis for dental procedures in patients with artificial joints. Am J Public Health 1989;79:739—43. [64] Clemens JD, Ransohoff DF. A quantitative assessment of predental antibiotic prophylaxis for patients with mitral-valve prolapse. J Chronic Dis 1984;37:531—44. [65] Devereux RB, Frary CJ, Kramer-Fox R, Roberts RB, Ruchlin HS. Cost-effectiveness of infective endocarditis prophylaxis for mitral valve prolapse with or without a mitral regurgitant murmur. Am J Cardiol 1994;74:1024—9. [66] Duval X, Leport C. Prophylaxis of infective endocarditis: current tendencies, continuing controversies. Lancet Infect Dis 2008;8:225—32. [67] Gould IM, Buckingham JK. Cost effectiveness of prophylaxis in dental practice to prevent infective endocarditis. Br Heart J 1993;70:79—83. [68] Lynch 3rd JP, Zhanel GG. Streptococcus pneumoniae: epidemiology and risk factors, evolution of antimicrobial resistance, and impact of vaccines. Curr Opin Pulm Med 2010;16: 217—25. [69] Société de Pathologie Infectieuse de Langue francaise. Recommendations for bone and joint prosthetic device infections in clinical practice (prosthesis, implants, osteosynthesis). Med Mal Infect 2010;40:185—211.