Authors: Berbari EF, Osmon DR, Hanssen AD, Baddour LM, Greene D, Harmsen WS, Mandrekar JN, Steckelberg JM, Virk A, Carr A, Kupp LI, Baughn LW, Wilson WR
Title: Prosthetic Joint Infection (PJI) Due to Dental Procedures
Institution: Mayo Clinic College of Medicine, Rochester, MN
Purpose: Many clinicians recommend antibiotic prophylaxis to prevent subsequent PJI due to dental procedures, despite the risk of prosthetic joint infection due to dental procedures and the efficacy of antibiotic prophylaxis being unknown.
Methods: We performed a prospective, single-center, case-control study between 2001-2006. Cases were patients hospitalized with total hip or knee infection. Controls were patients with a total hip or knee arthroplasty but without a prosthetic joint infection. Data regarding demographic features and potential risk factors were collected. Logistic regression was used to assess the association of variables with the odds of infection.
Results: There were 339 cases and 339 controls. There was no increased risk of total hip or knee infection in patients undergoing a high or low risk dental procedure who were not administered antibiotic prophylaxis, compared to patients not undergoing a dental procedure, (adjusted OR, 0.8 [95% CI, 0.4- to 1.6]; and adjusted OR, 0.6 [95% CI, 0.4-1.1]) respectively. Antibiotic prophylaxis in high or low risk dental procedures did not decrease the risk of subsequent total hip or knee infection (adjusted OR, 0.9 [95% CI, 0.5- to 1.6]; and adjusted OR, 1.2 [95% CI, 0.7-2.2]) respectively.
Discussion and Conclusion: Dental procedures were not a risk factor for subsequent total hip or knee infection. The use of antibiotic prophylaxis prior to dental procedures did not decrease the risk of subsequent total hip or knee infection. The practice of recommending antibiotic prophylaxis for dental procedures in patients with a joint arthroplasty should be reevaluated.