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Cortés-Penfield NW, Justo JA, McCreary EK, Ryder JH. Optimizing Antibiotic Therapy in Musculoskeletal Infections. Infect Dis Clin North Am 2025:S0891-5520(25)00014-5. [PMID: 40221230 DOI: 10.1016/j.idc.2025.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2025]
Abstract
Research into the optimal antibiotic management of musculoskeletal infections has advanced tremendously over the past quarter century, including over a dozen randomized controlled trials and numerous observational studies. This review examines the rationale for and evidence base supporting modern approaches to antibiotic decision making and stewardship in orthopedic infections. Specific practice advances discussed include the increased and earlier use of oral antibiotics, other principles of antibiotic selection (eg, the notion of "bone penetration" and novel local antimicrobial strategies), individualizing durations of therapy, and increasingly selective approaches to empiric antipseudomonal therapy, suppressive antibiotic therapy, and periprocedural antimicrobial prophylaxis following arthroplasty.
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Affiliation(s)
| | - Julie Ann Justo
- Department of Pharmacy, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Erin K McCreary
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jonathan H Ryder
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
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Young K, Zhuang T, Mavrommatis S, Hallman M, Serra-Lopez V, Berns E, Sobel AD. Does Perioperative Antibiotic Administration Decrease the Incidence of Prosthetic Joint Infection in Patients Undergoing Elective Soft Tissue Hand Surgery? J Hand Surg Am 2025; 50:459-465. [PMID: 39918528 DOI: 10.1016/j.jhsa.2025.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 11/24/2024] [Accepted: 01/01/2025] [Indexed: 04/05/2025]
Abstract
PURPOSE The use of prophylactic antibiotics in patients with existing total hip or knee arthroplasty undergoing elective hand surgery has not been studied. We tested the null hypothesis that perioperative antibiotic administration is not associated with the incidence of prosthetic joint infection (PJI) in patients undergoing elective, soft tissue hand surgery. METHODS We used a large, national administrative claims database to identify patients with existing total hip or knee arthroplasty undergoing soft tissue hand surgery (carpal tunnel release, de Quervain release, trigger finger release, limited palmar fasciectomy, ganglion or mucoid cyst removal, or soft tissue mass removal). Antibiotic prophylaxis was defined as the same day administration of intravenous cefazolin, vancomycin, or clindamycin. Patients receiving antibiotics were propensity score-matched in a 1:1 ratio to those who did not, accounting for age, sex, geographic region, insurance plan, subsequent surgeries, and the presence of comorbid diabetes mellitus, rheumatoid arthritis, myocardial infarction, congestive heart failure, chronic kidney disease, human immunodeficiency virus infection, chronic kidney disease, malignancy, obesity, or tobacco use. Residual differences between matched cohorts were adjusted for using multivariable logistic regression. The primary outcome was the incidence of PJI within 6, 9, and 12 months after hand surgery. RESULTS The overall incidence of PJI was 0.8% (166/21,582) within 12 months after hand surgery. There was no difference in the incidence of PJI between patients who received antibiotic prophylaxis and those who did not at 6 (0.3% vs 0.5%), 9 (0.6% vs 0.7%), or 12 months (0.7% vs 0.8%) after hand surgery. These findings were unchanged after adjusting for residual confounding. Surgical site infection within 3 months after hand surgery was also not associated with PJI at 6, 9, or 12 months. CONCLUSIONS We found no association between prophylactic antibiotic administration in patients with prior total hip or knee arthroplasty undergoing soft tissue hand surgery and the incidence of PJI at 6, 9, and 12 months after surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Kelsey Young
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Thompson Zhuang
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA.
| | | | - Mitchell Hallman
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | | | - Ellis Berns
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Andrew D Sobel
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
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Ergin M, Budin M, Canbaz SB, Ciloglu O, Salber J, Gehrke T, Citak M. Microbial Diversity of Periprosthetic Joint Infections in Diabetic and Nondiabetic Patients Following Hip Arthroplasty. J Arthroplasty 2025; 40:494-498. [PMID: 39187168 DOI: 10.1016/j.arth.2024.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/18/2024] [Accepted: 08/20/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a major complication following hip arthroplasty, leading to prolonged hospital stays, increased health care costs, and major morbidity. Diabetes mellitus is a prevalent comorbidity among hip arthroplasty patients, contributing to an increased risk of surgical complications, including infections. However, limited evidence exists regarding the microbial profiles of PJIs in diabetic patients compared to nondiabetic counterparts. METHODS We conducted a retrospective cohort study to investigate the microbial diversity of PJIs in diabetic and nondiabetic patients following hip arthroplasty. Medical records of patients who underwent hip arthroplasty procedures between 1996 and 2021 were reviewed. Patients diagnosed with PJI, based on the international consensus meeting, were included in the study. Microbiological data, including culture results, and risk factors were collected and analyzed. A total of 4,261 culture-positive patients diagnosed with PJI following hip arthroplasty were included in the analysis. RESULTS Microbiological analysis revealed a diverse spectrum of microbial pathogens, with Staphylococcus species being the most commonly isolated pathogen. Comparison between diabetic and nondiabetic patients revealed differences in the microbial profiles of PJIs, with diabetic patients more likely to be infected with specific pathogens, including Candida albicans (P = 0.01 odds ratio (OR) 2.8, confidence interval (CI) 1.2 to 6.2), Klebsiella pneumoniae (P = 0.03 OR 2.4, CI 1.0 to 5.6), Staphylococcus aureus (P = 0.04 OR 1.3, CI 1.0 to 1.8), Staphylococcus epidermidis (P < 0.001 (R 1.7, CI 1.4 to 2.2), Polymicrobial infections (P < 0.001 OR 1.5, CI 1.2 to 1.8), and Clostridium perfringens (P = 0.04 OR 5.9, CI 1.0 to 33.1). CONCLUSIONS Our study provides valuable insights into the microbial diversity of PJIs in diabetic and nondiabetic patients following hip arthroplasty. The identification of a tendency to different microbial profiles in diabetic patients underscores the need for tailored approaches to infection prevention and management in this high-risk population. Further research is needed to elucidate the underlying mechanisms and develop targeted interventions to improve patient outcomes.
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Affiliation(s)
- Musa Ergin
- ENDO-Klinik Hamburg Department of Orthopaedic Surgery, Hamburg, Germany; Department of Orthopedics and Traumatology, Cihanbeyli State Hospital, Konya, Turkey
| | - Maximilian Budin
- ENDO-Klinik Hamburg Department of Orthopaedic Surgery, Hamburg, Germany
| | - Sebati B Canbaz
- ENDO-Klinik Hamburg Department of Orthopaedic Surgery, Hamburg, Germany
| | - Osman Ciloglu
- ENDO-Klinik Hamburg Department of Orthopaedic Surgery, Hamburg, Germany
| | - Jochen Salber
- Department of Surgery, Ruhr-University Bochum, Bochum, Germany
| | - Thorsten Gehrke
- ENDO-Klinik Hamburg Department of Orthopaedic Surgery, Hamburg, Germany
| | - Mustafa Citak
- ENDO-Klinik Hamburg Department of Orthopaedic Surgery, Hamburg, Germany
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Pempe C, Schmalz G, Ziebolz D, Roth A. [Arthroplasty and oral health-an overview]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:782-788. [PMID: 39138653 DOI: 10.1007/s00132-024-04550-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/15/2024]
Abstract
Despite limited evidence for a preoperative dental screening examination and needs-based focal rehabilitation, as well as the need for antibiotic prophylaxis prior to invasive dental procedures, oral health is and remains a relevant topic in arthroplasty. The aspect of oral health should not be neglected in the future in connection with periprosthetic infections and should continue to be the subject of intensive research. The frequency of conspicuous dental findings in middle and old age underlines the importance of this problem. A dental examination prior to arthroplasty implantation can generally contribute to minimizing the risk of arthroplasty infection. It would be desirable for further studies to provide evidence on this topic in order to make recommendations for action. Independently of this, the development of an interdisciplinary guideline (arthroplasty and dentistry) on this topic should be encouraged. This could help to ensure that standardized treatment procedures are integrated into everyday clinical practice across the board.
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Affiliation(s)
- Christina Pempe
- Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - Gerhard Schmalz
- Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Dirk Ziebolz
- Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Andreas Roth
- Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
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Simon SJ, Aziz AA, Coden GS, Smith EL, Hollenbeck BL. Antibiotic Prophylaxis Prior to Dental Procedures After Total Hip and Knee Arthroplasty Does Not Decrease the Risk of Periprosthetic Joint Infection. J Arthroplasty 2024; 39:S420-S424. [PMID: 38401610 DOI: 10.1016/j.arth.2024.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a devastating complication after total hip and total knee arthroplasty (THA/TKA). While some guidelines no longer recommend routine use of prophylactic antibiotics for dental procedures, many surgeons continue to prescribe antibiotics for their THA/TKA patients. In a setting of increasing antibiotic resistance, it is important to reduce unnecessary antibiotic use. This study aims to evaluate antibiotics prior to dental procedures and the association between dental procedures and PJI. METHODS We conducted a retrospective cohort study of patients who underwent THA/TKA between January 1, 2019 and December 31, 2020. The primary outcome was late-presenting PJI, occurring > 90 days after surgery. Patients were designated in the antibiotic group (2,000 mg of amoxicillin) or non-antibiotic group based on their surgeon's prophylaxis protocol. Dental-associated PJIs were considered if the patient had evidence of poor dentition or a recent dental procedure prior to the onset of PJI symptoms. RESULTS There were 2,871 (26.4%) patients in the no antibiotics group and 8,023 (73.6%) patients in the antibiotics group. We found 27 (0.3%) late-presenting PJIs and 4 dental-associated PJIs. In the univariate and multivariable analyses, body mass index ≥-30 and revision surgery were the only variables that increased the odds of late-presenting PJI. All 4 dental-associated PJIs occurred in patients prescribed antibiotics. CONCLUSIONS We found a low rate of late-presenting PJI. Routine antibiotics prior to dental procedures were not shown to affect the risk of late-presenting PJI. These findings suggest that routine antibiotic prophylaxis before dental procedures is not necessary after THA/TKA.
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Affiliation(s)
- Samantha J Simon
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Alya A Aziz
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Gloria S Coden
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Eric L Smith
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts
| | - Brian L Hollenbeck
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts
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Gordon AM, Ng MK, Magruder ML, Schwartz JM, Jason Wong CH, Mont MA. The Association of Dental Caries or Dental Implant Placement Within One Year of Primary Total Hip Arthroplasty on Medical and Implant Complications. J Arthroplasty 2024; 39:2295-2302. [PMID: 38649065 DOI: 10.1016/j.arth.2024.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) adverse events among patients who have dental diagnoses remain unclear. We sought to determine if dental caries or dental implant placements increased (1) 90-day medical complications, (2) 90-day readmissions, and (3) 2-year implant-related complications, including periprosthetic joint infections (PJIs) after THA. METHODS A nationwide database for primary THAs from 2010 to 2021 was queried to compare 3 patient cohorts. Patients who had a history of dental implants or caries within 12 months prior to THA (n = 1,179) or 12 months after THA (n = 1,218) were case-matched to patients who did not have dental history (n = 6,090) by age and comorbidities. Outcomes included 90-day complications, 90-day readmissions, and 2-year implant-related complications. Logistic regression models computed the odds ratios (ORs) of complications and readmissions. P values less than .006 were significant. RESULTS Patients who had dental caries or implant placement 12 months before or after THA experienced 1.6-fold greater odds of 90-day medical complications compared to case-matched patients. Readmissions within 90 days increased for patients who had a dental history before (11.7% versus 8.3%; OR: 1.49, P < .0001) and after (14.2% versus 8.3%; OR: 1.84, P < .0001) THA compared to case-matched patients. A dental caries diagnosis or dental implant placement within 12 months following THA increased 2-year implant complications compared to case-matched patients (15.2% versus 9.3%; OR: 1.69, P < .0001), including PJIs (5.3% versus 2.8%; OR: 1.98, P < .0001), dislocations (4.4% versus 2.7%; OR: 1.63, P = .002), and THA revisions (3.9% versus 2.5%; OR: 1.61, P = .005). CONCLUSIONS Dental diagnoses within 12 months of THA are associated with increased medical complications. Dental diagnoses occurring 12 months after THA are associated with greater implant-related complications, including PJIs. Delaying invasive dental procedures for 12 months after THA may be advisable.
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Affiliation(s)
- Adam M Gordon
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York; Questrom School of Business, Boston University, Boston, Massachusetts
| | - Mitchell K Ng
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York
| | - Matthew L Magruder
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York
| | - Jake M Schwartz
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York
| | - Che Hang Jason Wong
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York
| | - Michael A Mont
- Rubin Institute of Orthopaedic Surgery, Department of Orthopaedic Surgery, Baltimore, Maryland
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Deer TR, Russo MA, Sayed D, Pope JE, Grider JS, Hagedorn JM, Falowski SM, Al-Kaisy A, Slavin KV, Li S, Poree LR, Eldabe S, Meier K, Lamer TJ, Pilitsis JG, De Andrés J, Perruchoud C, Carayannopoulos AG, Moeschler SM, Hadanny A, Lee E, Varshney VP, Desai MJ, Pahapill P, Osborn J, Bojanic S, Antony A, Piedimonte F, Hayek SM, Levy RM. The Neurostimulation Appropriateness Consensus Committee (NACC)®: Recommendations for the Mitigation of Complications of Neurostimulation. Neuromodulation 2024; 27:977-1007. [PMID: 38878054 DOI: 10.1016/j.neurom.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION The International Neuromodulation Society convened a multispecialty group of physicians based on expertise and international representation to establish evidence-based guidance on the mitigation of neuromodulation complications. This Neurostimulation Appropriateness Consensus Committee (NACC)® project intends to update evidence-based guidance and offer expert opinion that will improve efficacy and safety. MATERIALS AND METHODS Authors were chosen on the basis of their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from 2017 (when NACC last published guidelines) to October 2023. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on the strength of evidence or consensus when evidence was scant. RESULTS The NACC examined the published literature and established evidence- and consensus-based recommendations to guide best practices. Additional guidance will occur as new evidence is developed in future iterations of this process. CONCLUSIONS The NACC recommends best practices regarding the mitigation of complications associated with neurostimulation to improve safety and efficacy. The evidence- and consensus-based recommendations should be used as a guide to assist decision-making when clinically appropriate.
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Affiliation(s)
- Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA.
| | | | - Dawood Sayed
- The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Jay S Grider
- UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Adnan Al-Kaisy
- Guy's and St. Thomas National Health Service (NHS) Foundation Trust, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA; Neurology Section, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA
| | - Sean Li
- National Spine & Pain Centers, Shrewsbury, NJ, USA
| | - Lawrence R Poree
- Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA, USA
| | - Sam Eldabe
- The James Cook University Hospital, Middlesbrough, UK
| | - Kaare Meier
- Department of Anesthesiology (OPINord), Aarhus University Hospital, Aarhus, Arhus, Denmark; Department of Neurosurgery (Afd. NK), Aarhus University Hospital, Aarhus, Arhus, Denmark
| | | | | | - Jose De Andrés
- Valencia School of Medicine, Anesthesia Critical Care and Pain Management Department, General University Hospital, Valencia, Spain
| | | | - Alexios G Carayannopoulos
- Department of Physical Medicine and Rehabilitation and Comprehensive Spine Center, Rhode Island Hospital, Providence, RI, USA; Brown University Warren Alpert Medical School (Neurosurgery), Providence, RI, USA
| | - Susan M Moeschler
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amir Hadanny
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Eric Lee
- Mililani Pain Center, Mililani, HI, USA
| | - Vishal P Varshney
- Anesthesiology and Pain Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mehul J Desai
- International Spine, Pain & Performance Center, Virginia Hospital Center, Monument Research Institute, George Washington University School of Medicine, Arlington, VA, USA
| | - Peter Pahapill
- Functional Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Osborn
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Stana Bojanic
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ajay Antony
- The Orthopaedic Institute, Gainesville, FL, USA
| | - Fabian Piedimonte
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Salim M Hayek
- Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH, USA
| | - Robert M Levy
- Neurosurgical Services, Clinical Research, Anesthesia Pain Care Consultants, Tamarac, FL, USA
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Masuda S, Fukasawa T, Takeuchi M, Arai K, Matsuda S, Kawakami K. Association between dental procedures and periprosthetic joint infection: A case-crossover study. J Orthop Sci 2024; 29:1145-1148. [PMID: 37543500 DOI: 10.1016/j.jos.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/07/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Although the risk of dental procedures as a cause of bacteremia has been recognized, evidence regarding the association between dental procedures and late periprosthetic joint infection (LPJI) is scarce. We sought to determine whether dental procedures are associated with an increased risk of LPJI. METHODS The study was conducted under a case-crossover design using a large claims database in Japan. We identified adult patients who had undergone dental procedures and were hospitalized for LPJI between April 2014 and September 2021. Exposure to dental procedures was assessed during a case period of 1-4 weeks, with two control periods of 9-12 weeks and 17-20 weeks, preceding LPJI hospital admission. Conditional logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of LPJI associated with dental procedures in the case period compared with the two control periods. RESULTS In total, 241 patients with LPJI were included in the case-crossover study. At least one dental procedure was performed in 46 patients (19.1%) in the hazard period and in 75 patients (31.1%) in the control periods. The OR for LPJI with dental procedures was 0.96 (95% CI, 0.61-1.53; p = 0.88). Findings were robust in several sensitivity analyses, including stratification by whether the dental procedure included antibiotic prophylaxis. CONCLUSIONS This study suggests that dental procedures are not associated with increased risk of LPJI, and will raise questions about the recommendation for antibiotic prophylaxis before dental procedures.
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Affiliation(s)
- Soichiro Masuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Toshiki Fukasawa
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan; Department of Digital Health and Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Korenori Arai
- Department of Oral Implantology, Osaka Dental University, Hirakata, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
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Brenner JD, Atallah M, Yatsonsky D, Casabianca A, Hanna M. Higher Onset of Periprosthetic Joint Infections in Patients With Teeth Compared to Those Without Teeth. Cureus 2024; 16:e63696. [PMID: 39092322 PMCID: PMC11293887 DOI: 10.7759/cureus.63696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Bacteria can enter the bloodstream through simple actions such as brushing teeth, flossing, and even chewing food, increasing the chance of hematogenous seeding of prosthetic joints. Antibiotics before dental work in patients with orthopedic hardware is a topic of debate because of concerns for antibiotic resistance. Patients with dentures theoretically avoid this risk due to the lack of teeth and their maintenance. Most periprosthetic joint infections (PJIs) that occur in the first six months after surgery are due to wound infection, whereas late PJIs are more commonly caused by hematogenous seeding. MATERIALS AND METHODS Charts from patients who received primary total joint arthroplasty were interrogated for the condition of their teeth at the time of operation. If the patient had a PJI, the time from surgery and the organism responsible were noted. Multivariate linear regressions were performed for statistical analysis to compare rates of dental status, infection, comorbidities, and demographics. RESULTS From the 1,500 charts reviewed, patients with teeth and edentulous had similar rates of comorbidities. PJI patients had higher rates of chronic kidney disease than patients who did not have the infection. The overall rate of infections in patients with teeth was 2.14%, close to the national average. The rate of infection in patients without teeth was 0.78%. Patients with teeth have a higher rate of infection one month or longer from surgery than edentulous patients. CONCLUSIONS There was an increased infection rate in patients with teeth at six months and greater since the primary total joint arthroplasty. The organisms responsible for many of the PJIs are commonly found in the mouth of humans. Having teeth is a potential risk factor for late PJI.
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Affiliation(s)
- Joseph D Brenner
- College of Medicine and Life Sciences, The University of Toledo, Toledo, USA
| | - Marina Atallah
- College of Medicine and Life Sciences, The University of Toledo, Toledo, USA
| | - David Yatsonsky
- Orthopedic Surgery, The University of Toledo Medical Center, Toledo, USA
| | | | - Maged Hanna
- Orthopedic Surgery, The University of Toledo Medical Center, Toledo, USA
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10
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Li Y, Stewart CA, Finer Y. Advanced Antimicrobial and Anti-Infective Strategies to Manage Peri-Implant Infection: A Narrative Review. Dent J (Basel) 2024; 12:125. [PMID: 38786523 PMCID: PMC11120417 DOI: 10.3390/dj12050125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
Despite reductions in bacterial infection and enhanced success rate, the widespread use of systemic antibiotic prophylaxis in implant dentistry is controversial. This use has contributed to the growing problem of antimicrobial resistance, along with creating significant health and economic burdens. The basic mechanisms that cause implant infection can be targeted by new prevention and treatment methods which can also lead to the reduction of systemic antibiotic exposure and its associated adverse effects. This review aims to summarize advanced biomaterial strategies applied to implant components based on anti-pathogenic mechanisms and immune balance mechanisms. It emphasizes that modifying the dental implant surface and regulating the early immune response are promising strategies, which may further prevent or slow the development of peri-implant infection, and subsequent failure.
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Affiliation(s)
- Yihan Li
- Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto, ON M5G 1G6, Canada; (Y.L.); (C.A.S.)
| | - Cameron A. Stewart
- Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto, ON M5G 1G6, Canada; (Y.L.); (C.A.S.)
- Institute of Biomedical Engineering, University of Toronto, 164 College St., Toronto, ON M5S 3E2, Canada
| | - Yoav Finer
- Faculty of Dentistry, University of Toronto, 124 Edward St., Toronto, ON M5G 1G6, Canada; (Y.L.); (C.A.S.)
- Institute of Biomedical Engineering, University of Toronto, 164 College St., Toronto, ON M5S 3E2, Canada
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Srikrishnaraj A, Lanting BA, Burton JP, Teeter MG. The Microbial Revolution in the World of Joint Replacement Surgery. JB JS Open Access 2024; 9:e23.00153. [PMID: 38638595 PMCID: PMC11023614 DOI: 10.2106/jbjs.oa.23.00153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
Background The prevalence of revision surgery due to aseptic loosening and periprosthetic joint infection (PJI) following total hip and knee arthroplasty is growing. Strategies to prevent the need for revision surgery and its associated health-care costs and patient morbidity are needed. Therapies that modulate the gut microbiota to influence bone health and systemic inflammation are a novel area of research. Methods A literature review of preclinical and clinical peer-reviewed articles relating to the role of the gut microbiota in bone health and PJI was performed. Results There is evidence that the gut microbiota plays a role in maintaining bone mineral density, which can contribute to osseointegration, osteolysis, aseptic loosening, and periprosthetic fractures. Similarly, the gut microbiota influences gut permeability and the potential for bacterial translocation to the bloodstream, increasing susceptibility to PJI. Conclusions Emerging evidence supports the role of the gut microbiota in the development of complications such as aseptic loosening and PJI after total hip or knee arthroplasty. There is a potential for microbial therapies such as probiotics or fecal microbial transplantation to moderate the risk of developing these complications. However, further investigation is required. Clinical Relevance Modulation of the gut microbiota may influence patient outcomes following total joint arthroplasty.
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Affiliation(s)
- Arjuna Srikrishnaraj
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Brent A. Lanting
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Jeremy P. Burton
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Matthew G. Teeter
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
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12
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Webb ML. CORR Insights®: Are Dental Procedures Associated With Pyogenic Vertebral Osteomyelitis? Clin Orthop Relat Res 2024; 482:724-726. [PMID: 38064234 PMCID: PMC10936962 DOI: 10.1097/corr.0000000000002946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/10/2023] [Indexed: 03/16/2024]
Affiliation(s)
- Matthew L Webb
- Department of Orthopaedic Surgery, University of South Alabama, Mobile, AL, USA
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13
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Park HJ, Koh K, Choi YJ, Suh DH, D'Lima D, Kim JG. Is Prophylactic Antibiotic Use Necessary Before Dental Procedures in Primary and Revision TKA? A Propensity Score-matched, Large-database Study. Clin Orthop Relat Res 2024; 482:411-422. [PMID: 38231150 PMCID: PMC10871784 DOI: 10.1097/corr.0000000000002966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/05/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND The question of whether dental procedures increase the risk of periprosthetic joint infection (PJI) in patients who have undergone total joint arthroplasty (TJA) remains controversial. QUESTIONS/PURPOSES (1) Are dental procedures associated with an increased incidence of PJI in the setting of either primary or revision TKA after controlling for relevant potentially confounding variables? (2) Is the administration of prophylactic antibiotics before dental procedures associated with any differences in this risk? (3) Which factors are associated with increased incidence of PJI after dental procedures? METHODS This nationwide, retrospective, comparative, large-database study evaluated 591,602 patients who underwent unilateral primary or revision TKA between 2009 and 2019 using the Health Insurance Review and Assessment Service data in South Korea, in which all people in South Korea were registered and to which all medical institutions must charge any procedures they performed. The study population was divided into 530,156 patients with dental procedures and 61,446 patients without dental procedures based on whether the patients underwent a dental procedure at least 1 year after the index surgery. After propensity score matching, patients were classified into a dental (n = 182,052) and a nondental cohort (n = 61,422). The dental cohort was then divided into two groups: 66,303 patients with prophylactic antibiotics and 115,749 patients without prophylactic antibiotics based on prophylactic antibiotic use. After propensity score matching, patients were categorized into prophylactic (n = 66,277) and nonprophylactic (n = 66,277) cohorts. Propensity score matching was used to control for covariates including posttraumatic arthritis associated with PJI risk according to the dental procedure and prophylactic antibiotic use among the cohorts. After propensity score matching, the standardized mean difference was confirmed to be less than 0.1 for all variables. Kaplan-Meier survival analyses, log-rank tests, and Cox proportional hazards regression analysis was performed. RESULTS Dental procedures were not associated with an increase in PJI risk after primary (adjusted HR 1.56 [95% CI 0.30 to 8.15]; p = 0.60) or revision TKA (adjusted HR 1.74 [95% CI 0.90 to 3.34]; p = 0.10). Additionally, use of prophylactic antibiotics was not associated with a reduced PJI risk after the index surgery, either for primary (adjusted HR 1.28 [95% CI 0.30 to 5.42]; p = 0.74) or revision TKA (adjusted HR 0.74 [95% CI 0.45 to 1.23]; p = 0.25). Although surgery type and prophylactic antibiotic use exhibited no influence on PJI occurrence after dental procedures, posttraumatic arthritis was associated with PJI. The adjusted HR for posttraumatic arthritis was 4.54 (p = 0.046). CONCLUSION Our findings suggest that dental procedures were not associated with an increased risk of PJI for up to 2 years after the dental procedure in patients who underwent either primary or revision TKA. Based on these findings, there is insufficient rationale for the use of prophylactic antibiotics before dental procedures in patients who have undergone primary or revision TKA. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Hyung Jun Park
- Department of Orthopedic Surgery, Korea University College of Medicine, Ansan Hospital, Ansan-si, Gyeongki-do, South Korea
| | - Kyeol Koh
- Department of Dentistry, Catholic University College of Medicine, Eunpyeong St. Mary’s Hospital, Seoul, South Korea
- Department of Dental Science, Graduate School, Chosun University, Gwangju, South Korea
| | - Yoon Ji Choi
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Ansan Hospital Ansan-si, Gyeongki-do, South Korea
| | - Dong Hun Suh
- Department of Orthopedic Surgery, Korea University College of Medicine, Ansan Hospital, Ansan-si, Gyeongki-do, South Korea
| | - Darryl D'Lima
- The Scripps Research Institute and Shiley Center for Orthopedic Research and Education, La Jolla, CA, USA
| | - Jae Gyoon Kim
- Department of Orthopedic Surgery, Korea University College of Medicine, Ansan Hospital, Ansan-si, Gyeongki-do, South Korea
- The Scripps Research Institute and Shiley Center for Orthopedic Research and Education, La Jolla, CA, USA
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14
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Weiner TR, El-Najjar DB, Herndon CL, Wyles CC, Cooper HJ. How are Oral Antibiotics Being Used in Total Joint Arthroplasty? A Review of the Literature. Orthop Rev (Pavia) 2024; 16:92287. [PMID: 38283138 PMCID: PMC10821814 DOI: 10.52965/001c.92287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/17/2023] [Indexed: 01/30/2024] Open
Abstract
While the role and benefit of perioperative intravenous (IV) antibiotics in patients undergoing total joint arthroplasty (TJA) is well-established, oral antibiotic use in TJA remains a controversial topic with wide variations in practice patterns. With this review, we aimed to better educate the orthopedic surgeon on when and how oral antibiotics may be used most effectively in TJA patients, and to identify gaps in the literature that could be clarified with targeted research. Extended oral antibiotic prophylaxis (EOAP) use in high-risk primary, aseptic revision, and exchange TJA for infection may be useful in decreasing periprosthetic joint infection (PJI) rates. When prescribing oral antibiotics either as EOAP or for draining wounds, patient factors, type of surgery, and type of infectious organisms should be considered in order to optimally prevent and treat PJI. It is important to maintain antibiotic stewardship by administering the proper duration, dose, and type of antibiotics and by consulting infectious disease when necessary.
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Affiliation(s)
| | | | | | | | - H John Cooper
- Orthopedic Surgery Columbia University Medical Center
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15
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Dammling C, Gilmartin EM, Abramowicz S, Kinard B. Indications for Antibiotic Prophylaxis for Dentoalveolar Procedures. Dent Clin North Am 2024; 68:99-111. [PMID: 37951640 DOI: 10.1016/j.cden.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Antibiotic prophylaxis is the use of antibiotics perioperatively to prevent infections at the surgical site or distant locations. The decision to provide prophylaxis must balance risks of antibiotic resistance, adverse drug reactions, and increased health care costs with the benefit of decreasing infection. This determination has been studied extensively in patients with specific cardiac conditions and prosthetic joints. Prophylactic antibiotics in healthy patients have been shown to reduce the frequency of alveolar osteitis and decrease the failure rates of dental implants.
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Affiliation(s)
- Chad Dammling
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, 1919 7th Avenue South- Room 406, Birmingham, AL 35233, USA.
| | - Evan M Gilmartin
- School of Dentistry, University of Alabama at Birmingham, 1919 7th Avenue South, Birmingham, AL 35233, USA
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, 1365 Clifton Road, Building B, Suite 2300, Atlanta 30322, Georgia, USA
| | - Brian Kinard
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, 1919 7th Avenue South- Room 406, Birmingham, AL 35233, USA
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BASILE G, BIANCO PREVOT L, FOZZATO S, GALLINA M, DE NINA A, TRONCONI LP, ACCETTA R, AMADEI F, CICCARELLI A, LEIGHEB M. Periprosthetic joint infection and medico-legal dilemmas: algorithmic approach to diagnosis and strategies for prevention and risk management. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2024; 182. [DOI: 10.23736/s0393-3660.23.05311-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2025]
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17
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Eriksson HK, Lazarinis S, Järhult JD, Hailer NP. Early Staphylococcal Periprosthetic Joint Infection (PJI) Treated with Debridement, Antibiotics, and Implant Retention (DAIR): Inferior Outcomes in Patients with Staphylococci Resistant to Rifampicin. Antibiotics (Basel) 2023; 12:1589. [PMID: 37998791 PMCID: PMC10668653 DOI: 10.3390/antibiotics12111589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
It is unknown how rifampicin resistance in staphylococci causing a periprosthetic joint infection (PJI) affects outcomes after debridement, antibiotics, and implant retention (DAIR). We thus aimed to compare the risk of relapse in DAIR-treated early PJI caused by staphylococci with or without rifampicin resistance. In total, 81 patients affected by early PJI were included, and all patients were treated surgically with DAIR. This was repeated if needed. The endpoint of relapse-free survival was estimated using the Kaplan-Meier method, and Cox regression models were fitted to assess the risk of infection relapse for patients infected with rifampicin-resistant bacteria, adjusted for age, sex, type of joint, and type of index surgery. In patients with rifampicin-resistant staphylococci, relapse was seen in 80% after one DAIR procedure and in 70% after two DAIR procedures. In patients with rifampicin-sensitive bacteria, 51% had an infection relapse after one DAIR procedure and 33% had an infection relapse after two DAIR procedures. Patients with rifampicin-resistant staphylococcal PJI thus had an increased adjusted risk of infection relapse of 1.9 (95% CI: 1.1-3.6, p = 0.04) after one DAIR procedure compared to patients with rifampicin-sensitive bacteria and a 4.1-fold (95% CI: 1.2-14.1, p = 0.03) increase in risk of infection relapse after two DAIR procedures. Staphylococcal resistance to rifampicin is associated with inferior outcomes after DAIR. These findings suggest that DAIR may not be a useful strategy in early PJI caused by rifampicin-resistant staphylococci.
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Affiliation(s)
- Hannah K. Eriksson
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala University, 751 83 Uppsala, Sweden; (S.L.); (N.P.H.)
| | - Stergios Lazarinis
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala University, 751 83 Uppsala, Sweden; (S.L.); (N.P.H.)
| | - Josef D. Järhult
- Zoonosis Science Center, Department of Medical Sciences, Uppsala University, 751 83 Uppsala, Sweden;
| | - Nils P. Hailer
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala University, 751 83 Uppsala, Sweden; (S.L.); (N.P.H.)
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18
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Kwan SA, Lau V, Fliegel BE, Baker C, Courtney PM, Deirmengian GK. Routine Preoperative Dental Clearance for Total Joint Arthroplasty: Is There a Benefit? Cureus 2023; 15:e41352. [PMID: 37546155 PMCID: PMC10399090 DOI: 10.7759/cureus.41352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Background Periprosthetic joint infections (PJIs) place significant psychological and financial burdens on patients and healthcare systems. One measure to reduce the risk of PJIs is preoperative dental screening, for which there is no current consensus recommendation. This study aims to determine whether there is a difference in the rate of PJI and microorganism profile in patients who did and did not obtain preoperative dental clearance. Methodology A retrospective review was conducted among patients undergoing primary total hip arthroplasty and total knee arthroplasty from 2017 to 2021. A cohort of 8,654 patients who underwent routine dental clearance was matched with a cohort of patients who did not. Surgeons who changed their dental clearance protocol were also identified, and the rates of PJIs were compared before and after. Results No statistically significant difference was seen in the rate of PJIs between patients who did and did not undergo routine preoperative dental clearance. No statistically significant difference was seen in the rate of PJIs before and after for surgeons who changed their dental clearance protocol. The microorganism profile between the groups was also found to be without differences. Conclusions Eliminating dental clearance from routine preoperative clearance does not appear to increase the rates of acute PJIs following elective total joint arthroplasty (TJA) or to change the organism profile of the infections that did occur. It may be reasonable to not require routine preoperative dental clearance or to practice selective dental clearance in patients undergoing elective TJA, especially given the increased financial cost and delay in care experienced by patients.
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Affiliation(s)
- Stephanie A Kwan
- Orthopaedic Surgery, Jefferson Health New Jersey, Stratford, USA
| | - Vincent Lau
- Orthopaedic Surgery, Jefferson Health New Jersey, Stratford, USA
| | - Brian E Fliegel
- Orthopaedic Surgery, Jefferson Health New Jersey, Stratford, USA
| | - Colin Baker
- Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Paul M Courtney
- Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
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19
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Bains SS, Sax OC, Chen Z, Gilson GA, Nace J, Mont MA, Delanois RE. Antibiotic Prophylaxis is Often Unnecessary for Screening Colonoscopies Following Total Knee Arthroplasty. J Arthroplasty 2023; 38:S331-S336. [PMID: 36963530 DOI: 10.1016/j.arth.2023.03.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
INTRODUCTION Incidence of bacteremia following screening colonoscopy is low, but risk of hematogenous spread causing prosthetic joint infection (PJI) may exist in total knee arthroplasty (TKA) patients. In multivariate analyses, we examined PJI risk among three TKA cohorts: (1) colonoscopy recipients given antibiotic prophylaxis; (2) colonoscopy recipients not given antibiotic prophylaxis; and (3) no colonoscopy. We assessed: 90-day to one-year (A) PJI risk, and (B) risk factors for post-colonoscopy PJI. METHODS We queried a national, all-payer database for primary TKA recipients from 2010 to 2020. Patients who had colonoscopies and who did (n=2,558) or did not have antibiotic prophylaxis (n=20,000) were identified. These were compared those who did not undergo colonoscopy (n=20,000). The 20,000 patients were randomly selected to mitigate type 1 errors. Multivariate regressions compared PJI risk factors, such as alcohol abuse (AA), rheumatoid arthritis (RA), and diabetes. RESULTS Both colonoscopy cohorts had no increased PJI risk compared to non-colonoscopy (odds ratio (OR)<2.20, P≥0.064). Alcohol abuse, diabetes, and RA were found to be risk factors further enhancing likelihood of PJI for TKA patients not receiving antibiotics undergoing colonoscopies (OR>1.35, P≤0.044). CONCLUSION Overall, antibiotic prophylaxis does not decrease PJI risk following colonoscopy TKA recipients. After adjusting for known risk factors, both colonoscopy cohorts demonstrated similar PJI risks compared to the non-colonoscopy cohort. However, AA, diabetes, and RA were associated with further increased PJI risk for TKA patients undergoing colonoscopies compared to those who did not. Therefore, if undergoing colonoscopy after TKA, our findings suggest that most patients do not need to have antibiotics except for these high-risk patients.
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Affiliation(s)
- Sandeep S Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Oliver C Sax
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Zhongming Chen
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Gregory A Gilson
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - James Nace
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Ronald E Delanois
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland.
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20
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Gordon AM, Ng MK, Erez O, Wong CH, Mont MA. The Importance of Oral History: Does Dental Implant Placement or Caries One Year Before or After Primary Total Knee Arthroplasty Increase Medical Complications and Periprosthetic Joint Infections? J Arthroplasty 2023; 38:476-483. [PMID: 36252742 DOI: 10.1016/j.arth.2022.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Consensus regarding prior dental problems on the outcomes of total knee arthroplasty (TKA) patients is lacking. Therefore, our objectives were to determine the association of dental caries or dental implant placement in TKA patients on the following: (1) medical complications; (2) health care utilization (lengths of stay and readmissions); (3) implant-related complications; and (4) expenditures. METHODS A retrospective query was performed using an administrative claims database for 3 patient cohorts undergoing primary TKA from 2010 to 2020. Patients who had a history of dental caries or implant placement 1 year prior to TKA (n = 1,466) and 1 year after TKA (n = 1,127) were case-matched to patients who did not have a dental history by age and comorbidities. Outcomes included 90-day complications, health care utilization parameters, 2-year implant complications, and expenditures. Logistic regression models computed odds ratios (OR) of complications and readmissions. P values less than 0.005 were significant. RESULTS Patients who had a dental implant placement prior to TKA had higher frequency of complications (20.05 versus 14.01%; OR: 1.53, P < .0001), including myocardial infarctions (2.52 versus 1.23%; OR: 2.08, P = .0002) and pneumonia (2.52 versus 1.24%; OR: 2.06, P = .0002). Lengths of stay (3.28 versus 2.98 days; P = .255), readmission rates (4.71 versus 4.28%; P = .470), and implant-related complications including periprosthetic joint infections (3.14 versus 2.63%; OR: 1.20, P = .279) were similar between patients lacking dental history. Expenditures were higher in patients who had a postoperative and preoperative dental history ($19,252 versus $19,363 versus 17,980; P < .001). CONCLUSION Dental caries or implant placement may reflect overall worse medical condition resulting in more complications and higher costs after TKA. Dental history screening preoperatively may assist arthroplasty surgeons in minimizing complications.
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Affiliation(s)
- Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Orry Erez
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Che H Wong
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Michael A Mont
- Department of Orthopaedic Surgery, Rubin Institute of Orthopaedic Surgery, Baltimore, Maryland
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Stolzenberg L, Huang A, Usman M, Koch A, Stevenson J, Kihara C, Seale J. Rheumatoid Arthritis-Linked Artificial Joint Infections Leading to Amputations. Cureus 2023; 15:e35622. [PMID: 37007351 PMCID: PMC10065365 DOI: 10.7759/cureus.35622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/28/2023] [Indexed: 03/04/2023] Open
Abstract
Rheumatoid arthritis (RA) is a common autoimmune condition that can rarely cause more serious complications, such as permanent joint damage or infection, and may pose a significant additional risk during certain routine procedures. One major consequence of RA is that it can lead to serious and permanent joint damage requiring arthroplasty. Additionally, RA is a known cause of infection, with orthopedic prosthetic joint infections (PJIs) being documented. We explore one such serious case of a patient with long-term RA and a left knee joint replacement who presented to the emergency room with a serious PJI. History revealed that he repeatedly was affected by infections and had an extensive and severe clinical course, including nine revision surgeries. After a physical examination, imaging was performed, which further supported the diagnosis of joint infection. Considering the extensive number of attempts to salvage the joint, clinicians decided an above-knee amputation was necessary. This case highlights the fact that RA both increases the need for orthopedic arthroplasties and the risk of complications from these procedures, complicating clinical decision-making for physicians. Additionally, this patient had other underlying medical conditions and social habits that may have contributed to his severe clinical course, and we hope to explore these, discuss possible methods of modifying them, and assist clinicians in not only better treating similar patients but also emphasizing the importance of further developing standardized predictive algorithms and scoring tools.
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22
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Thornhill MH, Gibson TB, Pack C, Rosario BL, Bloemers S, Lockhart PB, Springer B, Baddour LM. Quantifying the risk of prosthetic joint infections after invasive dental procedures and the effect of antibiotic prophylaxis. J Am Dent Assoc 2023; 154:43-52.e12. [PMID: 36470690 DOI: 10.1016/j.adaj.2022.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/02/2022] [Accepted: 10/03/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Dentists face the expectations of orthopedic surgeons and patients with prosthetic joints to provide antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) to reduce the risk of late periprosthetic joint infections (LPJIs), despite the lack of evidence associating IDPs with LPJIs, lack of evidence of AP efficacy, risk of AP-related adverse reactions, and potential for promoting antibiotic resistance. The authors aimed to identify any association between IDPs and LPJIs and whether AP reduces LPJI incidence after IDPs. METHOD The authors performed a case-crossover analysis comparing IDP incidence in the 3 months immediately before LPJI hospital admission (case period) with the preceding 12-month control period for all LPJI hospital admissions with commercial or Medicare supplemental or Medicaid health care coverage and linked dental and prescription benefits data. RESULTS Overall, 2,344 LPJI hospital admissions with dental and prescription records (n = 1,160 commercial or Medicare supplemental and n = 1,184 Medicaid) were identified. Patients underwent 4,614 dental procedures in the 15 months before LPJI admission, including 1,821 IDPs (of which 18.3% had AP). Our analysis identified no significant positive association between IDPs and subsequent development of LPJIs and no significant effect of AP in reducing LPJIs. CONCLUSIONS The authors identified no significant association between IDPs and LPJIs and no effect of AP cover of IDPs in reducing the risk of LPJIs. PRACTICAL IMPLICATIONS In the absence of benefit, the continued use of AP poses an unnecessary risk to patients from adverse drug reactions and to society from the potential of AP to promote development of antibiotic resistance. Dental AP use to prevent LPJIs should, therefore, cease.
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Vidal P, Fourniols E, Junot H, Meloni C, Bleibtreu A, Aubry A. Antibiotic Stewardship in Treatment of Osteoarticular Infections Based on Local Epidemiology and Bacterial Growth Times. Microbiol Spectr 2022; 10:e0143022. [PMID: 36377888 PMCID: PMC9812015 DOI: 10.1128/spectrum.01430-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022] Open
Abstract
Incubation for 14 days is recommended for the culture of microorganisms from osteoarticular infections (OAI), but there are no recommendations for postoperative antibiotic stewardship concerning empirical antimicrobial therapy (EAT), while prolonging broad-spectrum EAT results in adverse effects. The aim of this study was to describe the local OAI epidemiology with consideration of bacterial growth times to determine which antibiotic stewardship intervention should be implemented in cases of negative culture after 2 days of incubation. We performed a 1-year, single-center, noninterventional cohort study at the Pitié-Salpêtrière hospital OAI reference center. Samples were taken as part of the local standard of care protocol for adult patients who underwent surgery for OAI (native or device related) and received EAT (i.e., piperacillin-tazobactam plus daptomycin [PTD]) following surgery. The time to culture positivity was monitored daily. Overall, 147 patients were recruited, accounting for 151 episodes of OAI, including 112 device-related infections. Microbiological cultures were positive in 144 cases, including 42% polymicrobial infections. Overall, a definitive microbiological result was obtained within 48 h in 118 cases (78%) and within 5 days in 130 cases (86%). After 5 days, only Gram-positive bacteria were recovered, especially Cutibacterium acnes, Staphylococcus spp., and Streptococcus spp. Overall, 90% of culture-positive OAI were correctly treated with the locally established EAT. EAT guidance for OAI was in agreement with our local epidemiology. Our results supported antibiotic stewardship intervention consisting of stopping piperacillin-tazobactam treatment at day 5 in cases of negative culture. IMPORTANCE Osteoarticular infections (OAI) remain challenging to diagnose and to treat. One of the issues concerns postoperative empirical antimicrobial therapy (EAT), which is usually a combination of broad-spectrum antibiotics. This EAT is maintained up to 2 weeks, until the availability of the microbiological results (identification and drug susceptibility testing of the microorganisms responsible for the OAI). Our results provide new data that will help to improve OAI management, especially EAT. Indeed, we have shown that antibiotic stewardship intervention consisting of stopping the antibiotic targeting Gram-negative bacteria included in the EAT could be implemented in cases where culture is negative after 5 days of incubation. The benefits of such an antibiotic stewardship plan include improved patient outcomes, reduced adverse events (including Clostridioides difficile infection), improvement in rates of susceptibilities to targeted antibiotics, and optimization of resource utilization across the continuum of care.
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Affiliation(s)
- Pauline Vidal
- AP-HP, Laboratoire de Bactériologie-Hygiène, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Eric Fourniols
- AP-HP, Service de Chirurgie orthopédique, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France
| | - Helga Junot
- AP-HP, Pharmacie à usage intérieure, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France
| | - Cyril Meloni
- AP-HP, Pharmacie à usage intérieure, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France
| | - Alexandre Bleibtreu
- AP-HP, Service des Maladies infectieuses et Tropicales, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France
| | - Alexandra Aubry
- AP-HP, Laboratoire de Bactériologie-Hygiène, Sorbonne-Université, Hôpital Pitié-Salpêtrière, Paris, France
- Sorbonne Université, Inserm, U1135, Centre d’Immunologie et des Maladies Infectieuses, Paris, France
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Dmitrov IA, Zagorodniy NV, Obolenskiy VN, Leval' PS, Zakharyan NG, Apresyan VS, Panin MA, Samkovich DA, Aliev RN, Grigoryan AA. Diagnosis and treatment of periprosthetic infection after hip replacement (a review). BULLETIN OF THE MEDICAL INSTITUTE "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) 2022. [DOI: 10.20340/vmi-rvz.2022.6.clin.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction. The frequency of hip arthroplasty is steadily increasing throughout the world and, although this operation has become routine, the likelihood of postoperative complications reaches 4.3 % [1]. The most dangerous of them are infectious lesions in the area of the endoprosthesis and adjacent tissues. At the same time, in addition to the threat of generalization of the infectious process, there are functional disorders in the joint area and a general deterioration in the quality of life of the patient. Timely diagnosis and treatment of the infectious process and related disorders can minimize the adverse effects of infection.Target. The purpose of this review is to analyze modern methods for diagnosing and treating periprosthetic infection resulting from hip replacement.Materials and methods. The subject literature was searched using the PubMed and Google Sholar databases.Results. The main methods for diagnosing periprosthetic infection include histological and bacteriological examination of the biopsy specimen, determination of sensitivity to antibiotics, blood, and synovial fluid analysis for the content of leukocytes, IL-6, CRP, PCR diagnostics of infectious agents. Treatment consists of re-intervention and/or antibiotic therapy.Conclusion. The most optimal method for diagnosing periprosthetic infection is a bacteriological study of biopsy specimens taken intraoperatively. The preferred method of treatment is determined by the severity of the infection, the degree of involvement of tissues adjacent to the prosthesis, the comorbid background, the nature of the infectious agent, and includes repeated revision surgery.
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Affiliation(s)
| | - N. V. Zagorodniy
- RUDN University; Pirogov Russian National Research Medical University
| | - V. N. Obolenskiy
- Pirogov Russian National Research Medical University; City Clinical Hospital No. 13
| | - P. Sh. Leval'
- City Clinical Hospital No. 13; European Clinic of Traumatology and Orthopedics (ECSTO)
| | | | | | - M. A. Panin
- RUDN University; City Clinical Hospital No. 17
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Gordon AM, Horn AR, Diamond KB, Roth ES, Weisberg MD, Sadeghpour R, Choueka J. The influence of prior dental pathology on medical complications and peri-prosthetic joint infections following primary shoulder arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03378-w. [PMID: 36030429 DOI: 10.1007/s00590-022-03378-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Antibiotic prophylaxis before invasive dental procedures is a common practice in the USA. Consensus regarding the influence of prior dental pathology (DP) on postoperative complications is lacking. The objectives are to determine the association of DP prior to shoulder arthroplasty (SA) on: (1) lengths of stay (LOS), (2) medical complications, (3) readmissions, (4) implant-related complications including peri-prosthetic joint infections (PJIs) and (5) healthcare expenditures. METHODS The PearlDiver database was queried for primary shoulder arthroplasty from 2010 to 2020. Patients with history of dental caries or dental implant placement before SA represented the study group (n = 1419). Patients without prior DP represented controls (n = 7062). Study group patients were 1:5 ratio matched to controls by age, sex, and comorbidities. Outcomes included LOS, 90-day complications, readmissions, 2-year implant-related complications, and healthcare reimbursements. Logistic regression was used to calculate odds ratios (OR) of complications and readmissions. T tests compared LOS and costs. P values < 0.003 were significant. RESULTS LOS (2.17 vs. 2.07 days; p = 0.071) were similar between groups. Patients with DP had higher 90-day medical complications compared to controls (OR: 1.74, p < 0.0001), including myocardial infarctions (2.2% vs. 0.8%; OR: 2.79, p < 0.0001), acute kidney injuries (8.3% vs. 4.6%; OR: 1.92, p < 0.0001), and pneumonias (8.7% vs. 5.3%; OR: 1.72, p < 0.0001). Readmission rates (1.97% vs. 1.54%; p = 0.248) were similar. Two-year implant complications were higher in patients with DP compared to controls (16.1% vs. 11.5%; OR: 1.38, p = 0.0003), including dislocations (6.4% vs. 4.5%; OR: 1.45, p = 0.002) and mechanical loosenings (4.0% vs. 2.4%; OR: 1.67, p = 0.001); however, PJIs were similar (2.2% vs. 1.9%; OR: 1.12, p = 0.583). Healthcare expenditures between groups were similar ($12,611 vs. $12,059; p = 0.075). CONCLUSION Patients with prior DP have higher 90-day medical complications and 2-year implant-related complications. Two-year incidence of PJIs were similar between groups. These findings can help shoulder surgeons counsel patients with a pertinent dental history. LEVEL OF EVIDENCE III Retrospective comparative study.
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Affiliation(s)
- Adam M Gordon
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA.
| | - Andrew R Horn
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Keith B Diamond
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Eric S Roth
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Miriam D Weisberg
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Ramin Sadeghpour
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Jack Choueka
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
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26
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Springer BD, Baddour LM, Lockhart PB, Thornhill MH. Antibiotic Prophylaxis for Prosthetic Joint Patients Undergoing Invasive Dental Procedures: Time for a Rethink? J Arthroplasty 2022; 37:1223-1226. [PMID: 35158002 DOI: 10.1016/j.arth.2022.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In the United States, it has been common practice to recommend that dentists provide antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) to prevent late periprosthetic joint infections (LPJIs) in patients who have prosthetic arthroplasties despite lack of evidence for a causal relationship between IDP and LPJI and a lack of evidence for AP efficacy. METHODS A recent study quantified the IDP incidence over the 15-month period prior to LPJI hospital admissions in the United Kingdom for which dental records were available. A case-crossover analysis compared IDP incidence in the 3 months before LPJI admission with the preceding 12 months. The English population was used because guidelines do not recommend AP and any relationship between IDPs and LPJI should be fully exposed. RESULTS No significant positive association was identified between IDPs and LPJI. Indeed, the incidence of IDPs was lower in the 3 months before LPJI hospital admission than that in the preceding 12 months. CONCLUSION In the absence of a significant positive association between IDPs and LPJI, there is no rationale to administer AP before IDPs in patients with prosthetic joints, particularly given the cost and inconvenience of AP, the risk of adverse drug reactions, and the potential for unnecessary AP use that promotes antibiotic resistance. These results should reassure orthopedic surgeons and their patients that dental care of patients who have prosthetic joints should focus on maintaining good oral hygiene rather than on recommending AP for IDPs. Moreover, it should also reassure those in other countries where AP is not recommended that such guidance is sufficient.
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Affiliation(s)
- Bryan D Springer
- OrthoCarolina Hip and Knee Center and Atrium Musculoskeletal Institute, Charlotte, NC
| | - Larry M Baddour
- Division of Infectious Diseases, Departments of Medicine and Cardiovascular Disease, Mayo Clinic College of Medicine, Rochester, MN
| | - Peter B Lockhart
- Department of Oral Medicine, Carolinas Medical Center - Atrium Health, Charlotte, NC
| | - Martin H Thornhill
- Department of Oral Medicine, Carolinas Medical Center - Atrium Health, Charlotte, NC; Unit of Oral & Maxillofacial Medicine Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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de Oliveira RCG, Gardev E, Shaddox LM. Dysbiotic relationship between arthritis and the oral-gut microbiome. A critical review. J Periodontal Res 2022; 57:711-723. [PMID: 35583216 DOI: 10.1111/jre.13002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/18/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
Arthritis and prosthetic joint infections (PJIs) overall are associated with reduced quality of life and limited work capacity. Multiple, overlapping factors contribute to these conditions. Some investigations have suggested a dysbiotic association between the oral-gut microbiome and pathogenesis of arthritis and PJIs. A better understanding of the role of the oral-gut microbiota in arthritis and PJI pathophysiology can shed light into how its disequilibrium can discharge a pro-inflammatory response, and impact the health of patients susceptible to arthritis or with established joint disease. A review of published in vivo and clinical data suggested that alterations in oral and gut microbiota can lead to a disturbance of immunoregulatory properties, and may be associated with joint infections and arthritis. This review brings new insights into the current status of the evidence on the potential molecules and inflammatory biomarkers disrupted by an oral-gut microbial dysbiosis. Normal commensals and pathogenic oral and gut microflora homeostasis are important not only to prevent infections per se but also its potential progression. Further experiments, especially controlled clinical trials, are needed to ascertain how microbiome manipulation and other microbiota-directed approaches can help control inflammation and effectively prevent and treat arthritic diseases. Additionally, studies on the effects of the long-term oral diseases, such as chronic periodontitis, on arthritis and PJIs need to be conducted.
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Affiliation(s)
- Rubelisa Candido Gomes de Oliveira
- Center for Oral Health Research, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA.,College of Dentistry, Federal University of Goias, Goiania, Goias, Brazil
| | - Elly Gardev
- Arizona State University, Tempe, Arizona, USA
| | - Luciana Macchion Shaddox
- Division of Periodontology and Center for Oral Health Research, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA
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Periprosthetic Joint Infection Following Clean Hand Surgery: A Systematic Review. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:208-213. [PMID: 35880154 PMCID: PMC9308167 DOI: 10.1016/j.jhsg.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/23/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose We assessed the rate of periprosthetic joint infection (PJI) following hand surgery in patients with prosthetic joints, and determined the efficacy of prophylactic antibiotics for preventing PJI in this patient subset. Methods A systematic review of PubMed (MEDLINE) and Scopus (EMBASE, MEDLINE, COMPENDEX) from 1968 to 2021 was conducted. Primary articles that studied PJIs following hand surgery in patients with prosthetic joints (hip, knee, shoulder, elbow, or ankle) and/or the use of prophylactic antibiotics prior to hand surgery in patients with prosthetic joints were included. Results A total of 3 studies (439,080 patients) met our inclusion criteria. Of the total study population, 9,070 patients (2.1%) had a prior total joint arthroplasty treated and subsequently underwent soft-tissue hand surgery. A single study reported a 0.2% prevalence of PJI secondary to hand surgery. The remaining 2 studies found no cases of PJI following hand surgery in patients with a history of total joint arthroplasty. On average, 16% (1,214 of 7,374) of patients with prosthetic joints received antibiotics prior to hand surgery. No significant relationships were found between hand surgery, antibiotic prophylaxis, and PJI risks. Conclusions There is a very low reported incidence of PJI following hand surgery in patients with existing prosthetic joints, with or without the use of prophylactic antibiotics. Therefore, the authors do not recommend the routine use of prophylactic antibiotics in this patient subgroup. The decision to use prophylaxis should be made on a case-by-case basis, accounting for patient-specific comorbidities and risk factors. Further research on hand surgery–associated PJI is warranted. Type of study/level of evidence Therapeutic III.
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Lockhart PB, Springer B, Baddour LM, Thornhill MH. Is it time to stop giving antibiotic prophylaxis to patients with prosthetic joints? J Am Dent Assoc 2022; 153:737-739. [DOI: 10.1016/j.adaj.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
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Rigotti E, Bianchini S, Nicoletti L, Monaco S, Carrara E, Opri F, Opri R, Caminiti C, Donà D, Giuffré M, Inserra A, Lancella L, Mugelli A, Piacentini G, Principi N, Tesoro S, Venturini E, Staiano A, Villani A, Sesenna E, Vicini C, Esposito S. Antimicrobial Prophylaxis in Neonates and Children Undergoing Dental, Maxillo-Facial or Ear-Nose-Throat (ENT) Surgery: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:382. [PMID: 35326845 PMCID: PMC8944694 DOI: 10.3390/antibiotics11030382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 12/10/2022] Open
Abstract
Surgical site infections (SSIs) represent a potential complication in surgical procedures, mainly because clean/contaminated surgery involves organs that are normally colonized by bacteria. Dental, maxillo-facial and ear-nose-throat (ENT) surgeries are among those that carry a risk of SSIs because the mouth and the first respiratory tracts are normally colonized by a bacterial flora. The aim of this consensus document was to provide clinicians with recommendations on surgical antimicrobial prophylaxis in neonates (<28 days of chronological age) and pediatric patients (within the age range of 29 days−18 years) undergoing dental, maxillo-facial or ENT surgical procedures. These included: (1) dental surgery; (2) maxilla-facial surgery following trauma with fracture; (3) temporo-mandibular surgery; (4) cleft palate and cleft lip repair; (5) ear surgery; (6) endoscopic paranasal cavity surgery and septoplasty; (7) clean head and neck surgery; (8) clean/contaminated head and neck surgery and (9) tonsillectomy and adenoidectomy. Due to the lack of pediatric data for the majority of dental, maxillo-facial and ENT surgeries and the fact that the recommendations for adults are currently used, there is a need for ad hoc studies to be rapidly planned for the most deficient areas. This seems even more urgent for interventions such as those involving the first airways since the different composition of the respiratory microbiota in children compared to adults implies the possibility that surgical antibiotic prophylaxis schemes that are ideal for adults may not be equally effective in children.
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Affiliation(s)
- Erika Rigotti
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (F.O.); (R.O.); (G.P.)
| | - Sonia Bianchini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
| | - Laura Nicoletti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
| | - Sara Monaco
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
| | - Elena Carrara
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy;
| | - Francesca Opri
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (F.O.); (R.O.); (G.P.)
| | - Roberta Opri
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (F.O.); (R.O.); (G.P.)
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy;
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy;
| | - Mario Giuffré
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90134 Palermo, Italy;
| | - Alessandro Inserra
- General Surgery Department, Bambino Gesu Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy;
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (L.L.); (A.V.)
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139 Florence, Italy;
| | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (F.O.); (R.O.); (G.P.)
| | | | - Simonetta Tesoro
- Division of Anesthesia, Analgesia, and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, 06129 Perugia, Italy;
| | - Elisabetta Venturini
- Pediatric Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy;
| | - Alberto Villani
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (L.L.); (A.V.)
| | - Enrico Sesenna
- Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, 43126 Parma, Italy;
| | - Claudio Vicini
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Piertoni Hospital, 47121 Forli, Italy;
| | - Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
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Salgado-Peralvo AO, Peña-Cardelles JF, Kewalramani N, Garcia-Sanchez A, Mateos-Moreno MV, Velasco-Ortega E, Ortiz-García I, Jiménez-Guerra Á, Végh D, Pedrinaci I, Monsalve-Guil L. Is Antibiotic Prophylaxis Necessary before Dental Implant Procedures in Patients with Orthopaedic Prostheses? A Systematic Review. Antibiotics (Basel) 2022; 11:93. [PMID: 35052970 PMCID: PMC8773220 DOI: 10.3390/antibiotics11010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/28/2021] [Accepted: 01/10/2022] [Indexed: 12/10/2022] Open
Abstract
As the population ages, more and more patients with orthopaedic prostheses (OPs) require dental implant treatment. Surveys of dentists and orthopaedic surgeons show that prophylactic antibiotics (PAs) are routinely prescribed with a very high frequency in patients with OPs who are about to undergo dental procedures. The present study aims to determine the need to prescribe prophylactic antibiotic therapy in patients with OPs treated with dental implants to promote their responsible use and reduce the risk of antimicrobial resistance. An electronic search of the MEDLINE database (via PubMed), Web of Science, LILACS, Google Scholar, and OpenGrey was carried out. The criteria used were those described by the PRISMA® Statement. No study investigated the need to prescribe PAs in patients with OPs, so four studies were included on the risk of infections of OPs after dental treatments with varying degrees of invasiveness. There is no evidence to suggest a relationship between dental implant surgeries and an increased risk of OP infection; therefore, PAs in these patients are not justified. However, the recommended doses of PAs in dental implant procedures in healthy patients are the same as those recommended to avoid infections of OPs.
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Affiliation(s)
- Angel-Orión Salgado-Peralvo
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (A.-O.S.-P.); (E.V.-O.); (I.O.-G.); (Á.J.-G.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
| | - Juan-Francisco Peña-Cardelles
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
- Department of Basic Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain
- Fellow Oral and Maxillofacial Surgery Department and Prosthodontics Department, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA
| | - Naresh Kewalramani
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
- Department of Nursery and Stomatology, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Alvaro Garcia-Sanchez
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT 06030, USA;
| | - María-Victoria Mateos-Moreno
- Department of Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Eugenio Velasco-Ortega
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (A.-O.S.-P.); (E.V.-O.); (I.O.-G.); (Á.J.-G.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
| | - Iván Ortiz-García
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (A.-O.S.-P.); (E.V.-O.); (I.O.-G.); (Á.J.-G.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
| | - Álvaro Jiménez-Guerra
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (A.-O.S.-P.); (E.V.-O.); (I.O.-G.); (Á.J.-G.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
| | - Dániel Végh
- Department of Prosthodontics, Semmelweis University, 1085 Budapest, Hungary;
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, 8010 Graz, Austria
| | - Ignacio Pedrinaci
- Section of Graduate Periodontology, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain;
- Department of Restorative Dentistry and Biomaterials Science, Harvard School of Dental Medicine, Harvard University, Boston, MA 02115, USA
| | - Loreto Monsalve-Guil
- Department of Stomatology, University of Seville, 41009 Seville, Spain; (A.-O.S.-P.); (E.V.-O.); (I.O.-G.); (Á.J.-G.); (L.M.-G.)
- Science Committee for Antibiotic Research of Spanish Society of Implants (SEI—Sociedad Española de Implantes), 28020 Madrid, Spain;
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Katz JN, Song ZS, Stanley EE, Lenhard NK, Silva GS, Chen A, Thornhill TS, Lange J, Collins JE, Selzer F, Losina E. Factors associated with use of antibiotic prophylaxis following dental procedures in total joint replacement recipients. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100217. [PMID: 36474765 PMCID: PMC9718251 DOI: 10.1016/j.ocarto.2021.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022] Open
Abstract
Background Total joint replacement recipients (TJR) are at risk for prosthetic joint infection (PJI), particularly those with comorbidities such as diabetes mellitus (DM) and rheumatoid arthritis (RA). Methods We mailed surveys to 1078 subjects undergoing primary TJR between 2011 and 2016 at an academic center. The survey asked about medical, dental, and orthopedic history and use of antibiotics prior to dental appointments. We generated adjusted relative risks (aRR) for using antibiotic prophylaxis less than always using Poisson regression, adjusting for demographic, clinical, and behavioral factors. Results We received surveys from 639 subjects; 597 were eligible and formed the analytical sample. 66 % reported always using antibiotic prophylaxis. DM and RA were not associated with prophylaxis use. Factors associated with less frequent use included: BMI ≥30 (aRR = 1.27, 95 % CI [1.01, 1.60]), dental cleanings <2 times/year (aRR = 1.95, 95 % CI [1.56, 2.43]), and expressing little concern (compared to neutral) about getting PJI (aRR = 1.23, 95 % CI [0.97, 1.55]), though this association was not statistically significant. Greater antibiotic use was reported in subjects who had ≥3 TJRs, (aRR = 0.48, 95 % CI [0.29, 0.80]), underwent more invasive dental procedures (aRR = 0.74, 95 % CI [0.59, 0.93]), and were concerned (vs. neutral) about PJI (aRR = 0.53, 95 %CI [0.33, 0.84]). Conclusions Two-thirds of TJR recipients in an academic center reported always using antibiotic prophylaxis prior to dental visits. Usage rates varied by demographics, BMI, number of TJRs, type of dental procedure, and behavioral factors -- but not by comorbidities associated with higher PJI risk.
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Affiliation(s)
- Jeffrey N. Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Zoey S. Song
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Elizabeth E. Stanley
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Nora K. Lenhard
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Genevieve S. Silva
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Angela Chen
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Thomas S. Thornhill
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Jeffrey Lange
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Jamie E. Collins
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Faith Selzer
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery and Division of Rheumatology, Immunity and Inflammation, Brigham and Women's Hospital, Harvard Medical School and the Department of Biostatistics, Boston University School of Public Health, United States
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Tye EY, Taylor AJ, Kay RD, Bryman JA, Andrawis JP, Runner RP. An Orthopedic Surgeon's Dental Examination: Reducing Unnecessary Delays in Joint Replacement Surgery for Marginalized Patients in a Safety Net Hospital System. Arthroplast Today 2021; 12:76-81. [PMID: 34805467 PMCID: PMC8585792 DOI: 10.1016/j.artd.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/01/2021] [Indexed: 12/01/2022] Open
Abstract
Background Selective dental clearance before total joint arthroplasty (TJA) has been proposed; however, effective strategies of carrying out this practice are lacking. This study aims to determine the positive predictive value (PPV) of a novel oral examination performed by an orthopedic surgeon to better direct limited resources for marginalized patients in a safety net hospital system. Methods A retrospective review was conducted on 105 consecutive patients who had an oral examination performed by a single surgeon before elective TJA. Patients who screened negative proceeded to surgery without further formal dental clearance. Patients who screened positive underwent formal examination/intervention by a dentist before surgery. The rate of correct referral that resulted in patients undergoing an oral surgical intervention was determined. Complications during a minimum 90-day postoperative follow-up period were collected and compared. Results Thirty patients (28.6%) screened positive while 75 patients (71.4%) screened negative and proceeded to surgery without referral. The PPV of the screening test was high, with 73.3% of patients receiving a major surgical oral intervention before TJA. Patients sent for formal referral required 89.1 more days to receive their surgery than those that screened negative (54.9 days ± 4.24 vs 144.0 days ± 82.4, P < .001). Conclusion An orthopedic surgeon’s oral examination demonstrates a high PPV to identify high-risk patients in need of an oral surgical intervention before TJA. This provides a unique solution regarding over-referral for preoperative dental clearance and avoids delays for marginalized patients considering elective TJA in a safety net hospital system.
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Affiliation(s)
- Erik Y Tye
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA.,Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
| | - Adam J Taylor
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA.,Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
| | - Robert D Kay
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA.,Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
| | - Jason A Bryman
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA.,Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
| | - John P Andrawis
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA.,Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
| | - Robert P Runner
- Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA
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Zhou MX, Berbari EF, Couch CG, Gruwell SF, Carr AB. Viewpoint: Periprosthetic joint infection and dental antibiotic prophylaxis guidelines. J Bone Jt Infect 2021; 6:363-366. [PMID: 34646729 PMCID: PMC8498598 DOI: 10.5194/jbji-6-363-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 12/02/2022] Open
Abstract
The purpose of this viewpoint is to provide a framework that is used within the Mayo Clinic to align recommendations from infectious disease experts, dental
specialists, and orthopedic surgeons with regards to need for antibiotic
prophylaxis prior to invasive dental procedures.
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Affiliation(s)
- Miao Xian Zhou
- Department of Dental Specialties, Division of Periodontics, Mayo Clinic, Rochester, MN, USA
| | - Elie F Berbari
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Cory G Couch
- Department of Medicine, Division of Orthopedics, Mayo Clinic, Rochester, MN, USA
| | - Scott F Gruwell
- Department of Dental Specialties, Division of Periodontics, Mayo Clinic, Rochester, MN, USA
| | - Alan B Carr
- Department of Dental Specialties, Division of Prosthodontics, Mayo Clinic, Rochester, MN, USA
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Bourbour S, Emaneini M, Jabalameli M, Mortazavi SMJ, Tahmasebi MN, Taghizadeh A, Sharafatvaziri A, Beigverdi R, Jabalameli F. Efficacy of 16S rRNA variable regions high-resolution melt analysis for bacterial pathogens identification in periprosthetic joint infections. BMC Microbiol 2021; 21:112. [PMID: 33849440 PMCID: PMC8045251 DOI: 10.1186/s12866-021-02164-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/22/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Accurate and rapid identification of microorganisms causing periprosthetic joint infections (PJIs) are necessary for choosing an appropriate antibiotic therapy. Therefore, molecular techniques are suggested for diagnosis in suspected PJIs. The Broad-range PCR and High-Resolution Melt Analysis (HRMA) were evaluated for the identification of causative organisms of PJIs in this study. RESULTS For 47 of 63 specimens, both the culture and broad-range PCR were positive. The culture was found to be able of organism's detection in 74.6% (47/63) of patients. Of 47 positive cultures, 11 (23.4%) were polymicrobial and 36 (76.59%) were monomicrobial cultures, in which 34 (91.89%) cases were detected by HRM assay. The sensitivity, specificity of HRMA vs monomicrobial culture were 91.89, 93.75%, respectively. The sensitivity, specificity of total HRMA (mono + poly) vs culture were 82.92, 93.75%. CONCLUSIONS HRM assay coupled with broad-range PCR are effective screening, rapid, and relatively cost-effective methods for discrimination of PJIs especially in aiding culture method. Using computer programs such as the Matlab-2018b program for HRM data analysis is also valuable and helpful in diagnosis.
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Affiliation(s)
- Samaneh Bourbour
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Emaneini
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Jabalameli
- Department of Orthopedic Surgery, Shafa Yahyaiyan Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Javad Mortazavi
- Department of Orthopedic Surgery, Imam Khomaini Hospital, Tehran University of Medical Sciences, knee and hip surgeon, Tehran, Iran
| | - Mohamad Naghi Tahmasebi
- Department of Orthopedic Surgery, Imam Khomaini Hospital, Tehran University of Medical Sciences, knee and hip surgeon, Tehran, Iran
| | - Amirheckmat Taghizadeh
- School of Electrical and Computer engineering, college of engineering, University of Tehran, Tehran, Iran
| | - Arash Sharafatvaziri
- Department of Orthopedic Surgery, Imam Khomaini Hospital, Tehran University of Medical Sciences, knee and hip surgeon, Tehran, Iran
| | - Reza Beigverdi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Jabalameli
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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36
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Goff DA, Mangino JE, Glassman AH, Goff D, Larsen P, Scheetz R. Review of Guidelines for Dental Antibiotic Prophylaxis for Prevention of Endocarditis and Prosthetic Joint Infections and Need for Dental Stewardship. Clin Infect Dis 2021; 71:455-462. [PMID: 31728507 DOI: 10.1093/cid/ciz1118] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022] Open
Abstract
Dentists prescribe 10% of all outpatient antibiotic prescriptions, writing more than 25.7 million prescriptions per year. Many are for prophylaxis in patients with prosthetic joint replacements; the American Dental Society states that "in general," prophylactic antibiotics are not recommended to prevent prosthetic joint infections. Orthopedic surgeons are concerned with the risk of implant infections following a dental procedure and, therefore, see high value and low risk in recommending prophylaxis. Patients are "stuck in the middle," with conflicting recommendations from orthopedic surgeons (OS) and dentists. Unnecessary prophylaxis and fear of lawsuits amongst private practice dentists and OS has not been addressed. We review The American Heart Association/American College of Cardiology, American Dental Association, and American Association of Orthopedic Surgeons' guidelines on dental antibiotic prophylaxis for the prevention of endocarditis and prosthetic joint infections. We provide experience on how to engage private-practice dentists and OS in dental stewardship using a community-based program.
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Affiliation(s)
- Debra A Goff
- The Ohio State University Wexner Medical Center, The Ohio State University College of Pharmacy, Columbus, Ohio, USA
| | - Julie E Mangino
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Andrew H Glassman
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Douglas Goff
- Drs. Gilbert and Goff Prosthodontists, Columbus, Ohio, USA
| | - Peter Larsen
- Division of Oral and Maxillofacial Surgery and Dental Anesthesiology, The Ohio State University College of Dentistry, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard Scheetz
- Drs. Scheetz and Rekos Oral and Facial Surgeons of Ohio, Dublin, Ohio, USA
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File TM, Bleasdale SC. Early Steps Toward Ambulatory Antimicrobial Stewardship: Dental and Orthopedic Focus. Clin Infect Dis 2021; 71:463-465. [PMID: 31728516 DOI: 10.1093/cid/ciz1124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/13/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Thomas M File
- Division of Infectious Diseases, Summa Health, Akron, Ohio, USA
| | - Susan C Bleasdale
- Internal Medicine, Division of Infectious Diseases, University of Illinois at Chicago, Chicago, Illinois, USA
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Trends of Prosthetic Joint Infection Organisms and Recurrence for a Single High-Volume Arthroplasty Surgeon Over 20 Years. J Arthroplasty 2021; 36:1101-1108. [PMID: 33160807 DOI: 10.1016/j.arth.2020.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 09/11/2020] [Accepted: 10/04/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) is a morbid complication following total joint arthroplasty (TJA). PJI diagnosis and treatment has changed over time, and patient co-management with a high-volume musculoskeletal infectious disease (MSK ID) specialist has been implemented at our institution in the last decade. METHODS We retrospectively evaluated all consecutive TJA patients treated for PJI between 1995 and 2018 by a single high-volume revision TJA surgeon. Microbial identities, antibiotic resistance, prior PJI, and MSK ID consultation were investigated. RESULTS In total, 261 PJI patients (median age 66 years, interquartile range 57-75) were treated. One-year and 5-year reinfection rates were 15.8% (95% confidence interval [CI] 11.6-20.7) and 22.1% (95% CI 17.0-27.7), respectively. Microbial identities and antibiotic resistances did not change significantly over time. Despite seeing more prior PJI patients (53.3% vs 37.6%, P = .012), MSK ID-managed patients had similar infection rates as non-MSK ID-managed patients (hazard ratio [HR] 1.02, 95% CI 0.6-1.75, P = .93). Prior PJI was associated with higher reinfection risk (HR 2.39, 95% CI 1.39-4.12, P = .002) overall and in patients without MSK ID consultation, specifically (HR 2.78, 95% CI 1.37-5.65, P = .005). This risk was somewhat lower and did not reach significance in prior PJI patients with MSK ID consultation (HR 1.97, 95% CI 0.87-4.48, P = .106). CONCLUSION We noted minimal differences in microbial/antibiotic resistances for PJI over 20 years in a single institution, suggesting current standards of PJI treatment remain encouragingly valid in most cases. MSK ID involvement was not associated with lower reinfection risk overall; however, in patients with prior PJI, the risk of reinfection appeared to be somewhat lower with MSK ID involvement. LEVEL OF EVIDENCE Level IV-Case Series.
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Young JR, Bannon AL, Anoushiravani AA, Posner AD, Adams CT, DiCaprio MR. Oral health implications in total hip and knee arthroplasty patients: A review. J Orthop 2021; 24:126-130. [PMID: 33679037 PMCID: PMC7930502 DOI: 10.1016/j.jor.2021.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/14/2021] [Indexed: 12/19/2022] Open
Abstract
Over the past two decades, oral health has emerged as a health care priority. Historically, patients greater than 65 years of age, the economically disadvantaged, members of racial or ethnic minority groups, or the disabled or home bound have experienced significant barriers to routine dental care. The connection between oral health care and periprosthetic joint infections (PJI) continues to be of importance to the orthopedic surgeon, as such infections are significantly morbid and costly. This review aims to introduce the importance of oral health as a small but crucial portion of an arthroplasty patient's overall perioperative management.
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Affiliation(s)
- Joseph R. Young
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Annika L. Bannon
- Department of Family Medicine, Albany Medical Center, Albany, NY, USA
| | | | - Andrew D. Posner
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Curtis T. Adams
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
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40
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Van Belleghem JD, Manasherob R, Miȩdzybrodzki R, Rogóż P, Górski A, Suh GA, Bollyky PL, Amanatullah DF. The Rationale for Using Bacteriophage to Treat and Prevent Periprosthetic Joint Infections. Front Microbiol 2020; 11:591021. [PMID: 33408703 PMCID: PMC7779626 DOI: 10.3389/fmicb.2020.591021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/24/2020] [Indexed: 12/19/2022] Open
Abstract
Prosthetic joint infection (PJI) is a devastating complication after a joint replacement. PJI and its treatment have a high monetary cost, morbidity, and mortality. The lack of success treating PJI with conventional antibiotics alone is related to the presence of bacterial biofilm on medical implants. Consequently, surgical removal of the implant and prolonged intravenous antibiotics to eradicate the infection are necessary prior to re-implanting a new prosthetic joint. Growing clinical data shows that bacterial predators, called bacteriophages (phages), could be an alternative treatment strategy or prophylactic approach for PJI. Phages could further be exploited to degrade biofilms, making bacteria more susceptible to antibiotics and enabling potential combinatorial therapies. Emerging research suggests that phages may also directly interact with the innate immune response. Phage therapy may play an important, and currently understudied, role in the clearance of PJI, and has the potential to treat thousands of patients who would either have to undergo revision surgery to attempt to clear an infections, take antibiotics for a prolonged period to try and suppress the re-emerging infection, or potentially risk losing a limb.
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Affiliation(s)
- Jonas D. Van Belleghem
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Robert Manasherob
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States
| | - Ryszard Miȩdzybrodzki
- Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland
| | - Paweł Rogóż
- Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland
| | - Andrzej Górski
- Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland
| | | | - Paul L. Bollyky
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Derek F. Amanatullah
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, United States
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Kocazeybek E, Demirel M, Ersin M, Ergin ON, Sadic B, Yavuz SS, Asik M. Abiotrophia defectiva as a Rare Causative Agent of Periprosthetic Total Knee Arthroplasty Infections: A Case Report and Literature Review. J Lab Physicians 2020; 12:219-221. [PMID: 33268940 PMCID: PMC7684990 DOI: 10.1055/s-0040-1720942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
We present a case of Abiotrophia defectiva in a prosthetic knee infection following total knee replacement for the first time. A 69-year-old female was prediagnosed with prosthetic knee infection, and a two-stage revision arthroplasty was applied. A. defectiva was cultured by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) from the synovial fluid aspirates. Penicillin G and gentamicin had been administered. One year postoperatively, a scintigraphy showed no recurrence. A. defectiva may be missed in culture negative patients with knee or hip arthroplasty. They should be carefully evaluated if they have undergone recent dental procedures.
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Affiliation(s)
- Emre Kocazeybek
- Department of Orthopedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mehmet Demirel
- Department of Orthopedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mehmet Ersin
- Department of Orthopedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Omer Naci Ergin
- Department of Orthopedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Betul Sadic
- Department of Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Serap Simsek Yavuz
- Department of Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mehmet Asik
- Department of Orthopedics and Traumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Amin Yavari S, Castenmiller SM, van Strijp JAG, Croes M. Combating Implant Infections: Shifting Focus from Bacteria to Host. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e2002962. [PMID: 32914481 DOI: 10.1002/adma.202002962] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/28/2020] [Indexed: 05/06/2023]
Abstract
The widespread use of biomaterials to support or replace body parts is increasingly threatened by the risk of implant-associated infections. In the quest for finding novel anti-infective biomaterials, there generally has been a one-sided focus on biomaterials with direct antibacterial properties, which leads to excessive use of antibacterial agents, compromised host responses, and unpredictable effectiveness in vivo. This review sheds light on how host immunomodulation, rather than only targeting bacteria, can endow biomaterials with improved anti-infective properties. How antibacterial surface treatments are at risk to be undermined by biomaterial features that dysregulate the protection normally provided by critical immune cell subsets, namely, neutrophils and macrophages, is discussed. Accordingly, how the precise modification of biomaterial surface biophysical cues, or the incorporation of immunomodulatory drug delivery systems, can render biomaterials with the necessary immune-compatible and immune-protective properties to potentiate the host defense mechanisms is reviewed. Within this context, the protective role of host defense peptides, metallic particles, quorum sensing inhibitors, and therapeutic adjuvants is discussed. The highlighted immunomodulatory strategies may lay a foundation to develop anti-infective biomaterials, while mitigating the increasing threat of antibacterial drug resistance.
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Affiliation(s)
- Saber Amin Yavari
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, 3508GA, The Netherlands
| | - Suzanne M Castenmiller
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, 3508GA, The Netherlands
| | - Jos A G van Strijp
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, 3508GA, The Netherlands
| | - Michiel Croes
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, 3508GA, The Netherlands
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Abstract
Over the past 2 decades, personal digital devices have evolved to become portable, attractive, readily accessible, interactive, and ubiquitous. Although digital and social media have evidence-based benefits, including early learning, exposure to new ideas and knowledge, and increased opportunities for social contact and support, unsupervised and unchecked use of personal digital devices can have negative consequences for the physical and mental health of children in their formative years.The widespread use of portable digital devices has been accompanied by a concomitant rise in the prevalence of physical and mental health issues in children. Research suggests an association between these trends, which also may be considered from a public health perspective. Proposed interventions include the development and implementation of individual family media use plans for children of all ages.
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Slullitel PA, Oñativia JI, Piuzzi NS, Higuera-Rueda C, Parvizi J, Buttaro MA. Is there a Role for Antibiotic Prophylaxis Prior to Dental Procedures in Patients with Total Joint Arthroplasty? A Systematic Review of the Literature. J Bone Jt Infect 2020; 5:7-15. [PMID: 32117684 PMCID: PMC7045525 DOI: 10.7150/jbji.40096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/13/2019] [Indexed: 12/29/2022] Open
Abstract
Background: The indication of prophylactic antibiotics prior to dental procedures for non-infected causes in order to reduce the risk of haematogenous periprosthetic joint infection (PJI) remains as controversial. We performed a systematic review of the literature assessing the relationship between PJI and invasive dental procedures and whether there is evidence to support the use of antibiotic prophylaxis. Methods: This review was conducted in accordance with the 2009 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were searched for studies focusing on dental procedures after TJA, reporting on PJI as an outcome. The methodological quality was assessed with the Newcastle-Ottawa quality assessment scale for case-control and cohort studies and by the tool proposed by Murad et al. for observational studies. Results: Our systematic literature review yielded 90 individual studies, of which 9 met the inclusion criteria. The overall infection rate ranged from 0.26% to 2.12%. Of these, cases associated with a dental procedure ranged from 0% to 15.9%. Five of the studies described cases in which antibiotic prophylaxis was administered; however, no clear algorithm regarding type and dosage of antibiotic was mentioned. When assessing the methodological quality of the evidence, all studies had an overall low to moderate quality. Conclusion: The current systematic review, mostly composed of low-quality studies, suggests that there is no direct evidence to indicate prophylactic antibiotics prior to dental procedures in patients with TJA. In line with the current guidelines, no prophylaxis should be used on interventions for non-infected causes, except for occasional unusual situations, which can then be judged individually.
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Affiliation(s)
- Pablo Ariel Slullitel
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - José Ignacio Oñativia
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Nicolás Santiago Piuzzi
- Adult Reconstructive Surgery, Division of Orthopaedic Surgery, Cleveland Clinic, Ohio, United States
| | - Carlos Higuera-Rueda
- Adult Reconstructive Surgery, Division of Orthopaedic Surgery, Cleveland Clinic, Ohio, United States
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; United States
| | - Martín Alejandro Buttaro
- Hip Surgery Unit, Institute of Orthopaedics “Carlos E. Ottolenghi”, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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45
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Cochrane NH, Pachter CS, Garfinkel JH, Gladnick TB, Gladnick EP, Romness DW, Gladnick BP. Patient perceptions of antibiotic prophylaxis for dental procedures after total joint arthroplasty. J Orthop 2020; 17:22-24. [DOI: 10.1016/j.jor.2019.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/30/2019] [Accepted: 08/13/2019] [Indexed: 11/25/2022] Open
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Lespasio M, Mont M, Guarino A. Identifying Risk Factors Associated With Postoperative Infection Following Elective Lower-Extremity Total Joint Arthroplasty. Perm J 2020; 24:1-3. [PMID: 33482967 DOI: 10.7812/tpp/20.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article addresses the importance of identifying risk factors associated with postoperative infection following elective lower-extremity total joint arthroplasty. Specifically, this review discusses risk factors recognized by the American Academy of Orthopaedic Surgeons that should be carefully considered and assessed by the orthopaedic team in collaboration with the primary care provider before proceeding with surgery.
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Affiliation(s)
- Michelle Lespasio
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA
| | - Michael Mont
- Northwell Health Physician Partners Orthopaedic Institute at Lenox Hill, Lenox Hill Hospital, New York, NY
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Müller Campanile V, Megally A, Campanile G, Gayet-Ageron A, Giannopoulou C, Mombelli A. Risk factors for recurrence of periodontal disease in patients in maintenance care in a private practice. J Clin Periodontol 2019; 46:918-926. [PMID: 31271667 DOI: 10.1111/jcpe.13165] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/03/2019] [Accepted: 06/30/2019] [Indexed: 11/28/2022]
Abstract
AIM To assess periodontal and dental conditions in individuals in maintenance care after periodontal therapy in private practice, and to identify risk factors for recurrence of disease and tooth loss. MATERIALS AND METHODS One hundred patients attending a routine recall visit were included. All had been treated for periodontal disease and were in maintenance since ≥ 2 years. RESULTS Examinations took place 18.0 (±8.71) years after the start of periodontal therapy. A total of 40.1 ± 22.5 recall visits were registered during this time. 91% of the participants had an initial diagnosis of chronic, 9% of aggressive periodontitis. The average participant was 46 years old and had 26 teeth. 283 of 2,549 initially present teeth were lost, half of them being molars. Periodontal and endo-periodontal complications accounted for only 16 lost teeth. The prevalence of all probing depth (PD) categories decreased significantly. The longer the time, the more frequent the recall visits, and the more was spent during the maintenance phase, the greater was the reduction. Multivariate analysis rendered BMI and smoking as factors influencing number of sites with PD ≥ 4 mm and bleeding on probing. CONCLUSION Tooth loss and periodontal tissue damage can be contained over prolonged periods if periodontal disease is treated and patients attend regular maintenance care.
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Affiliation(s)
| | - Andrew Megally
- Division of Periodontology, University Clinic of Dental Medicine, University of Geneva, Geneva, Switzerland
| | | | - Angèle Gayet-Ageron
- CRC & Division of Clinical Epidemiology, Department of Health and Community Medicine, University Hospitals Geneva, Geneva, Switzerland
| | - Catherine Giannopoulou
- Division of Periodontology, University Clinic of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Andrea Mombelli
- Division of Periodontology, University Clinic of Dental Medicine, University of Geneva, Geneva, Switzerland
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Moreira AI, Mendes L, Pereira JA. Is there scientific evidence to support antibiotic prophylaxis in patients with periodontal disease as a means to decrease the risk of prosthetic joint infections? A systematic review. INTERNATIONAL ORTHOPAEDICS 2019; 44:231-236. [PMID: 31754752 DOI: 10.1007/s00264-019-04433-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/03/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE To re-assess the scientific literature to ascertain if there is scientific evidence to support antibiotic prophylaxis in patients with periodontal disease as a means to decrease the risk of prosthetic joint infections. INTRODUCTION Prosthetic joint infections occur in approximately 0.3-2% of patients and, of these, around 6-13% are thought to be caused by oral bacteria. Antibiotic prophylaxis prior to dental procedures as a means to prevent a prosthetic joint infection has been controversial throughout the years. However, it remains unclear to what extent it has a beneficial effect. We do know that bacteraemia of oral origin is directly proportional to any ongoing inflammation or infection, and that a diseased periodontium may act as an entry for bacteria to spread to distant locations, through the bloodstream, and potentially be the cause of distant site infections. MATERIALS AND METHODS Updated literature search using the PubMed (Medline), and the Clarivate Analytics databases, to identify eligible articles since the previous searches up to April 2019 (last 5 years). RESULTS No studies that relate periodontal disease to the development of a prosthetic joint infection were found. CONCLUSION Currently, there is no evidence to support or exclude the need of antibiotic prophylaxis as a means to decrease the risk of prosthetic joint infections in patients with periodontal disease.
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Affiliation(s)
- Ana Isabel Moreira
- Faculty of Dental Medicine of University of Porto, Rua Dr. Manuel Pereira da Silva, 4200-393, Porto, Portugal.
| | - Luzia Mendes
- Faculty of Dental Medicine of University of Porto, Rua Dr. Manuel Pereira da Silva, 4200-393, Porto, Portugal
| | - José António Pereira
- Faculty of Dental Medicine of University of Porto, Rua Dr. Manuel Pereira da Silva, 4200-393, Porto, Portugal
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Coll PP, Lindsay A, Meng J, Gopalakrishna A, Raghavendra S, Bysani P, O'Brien D. The Prevention of Infections in Older Adults: Oral Health. J Am Geriatr Soc 2019; 68:411-416. [PMID: 31479533 DOI: 10.1111/jgs.16154] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/31/2019] [Accepted: 08/03/2019] [Indexed: 12/17/2022]
Abstract
The oral cavity is exposed to the external environment and from a very young age is colonized by infectious agents. Under certain circumstances including poor oral hygiene, dry mouth, trauma, and the use of antibiotics, oral infections can occur. They can result in damage to the oral cavity including teeth and their support structures. Oral infections can also lead to the extension of infection into surrounding tissues and to systemic infections. Chronic oral infection is a recognized risk factor for heart disease. Older adults are at high risk for oral infections and associated complications. Tooth loss, for which infection is the most significant cause, leads to cosmetic changes and a decreased ability to masticate certain foods that can lead to malnutrition. Chronic oral infections and the manipulation of teeth and supporting structures can lead to the hematogenous spread of infection including the infection of artificial joints and endocardial implants. Good oral hygiene, the use of fluoride, regular dental care, and the appropriate use of antibiotics can all reduce oral infections and their associated complications. J Am Geriatr Soc 68:411-416, 2020.
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Affiliation(s)
- Patrick P Coll
- Department of Family Medicine & Center on Aging, University of Connecticut Health Center, Farmington, Connecticut
| | - Adam Lindsay
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut
| | - Joyce Meng
- Department of Medicine, Division of Cardiology, University of Connecticut Health Center, Farmington, Connecticut
| | - Aadarsh Gopalakrishna
- Division of General Dentistry, University of Connecticut Health Center, Farmington, Connecticut
| | - Sree Raghavendra
- Division of General Dentistry, University of Connecticut Health Center, Farmington, Connecticut
| | - Pooja Bysani
- Division of General Dentistry, University of Connecticut Health Center, Farmington, Connecticut
| | - Daniel O'Brien
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut
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Sonn KA, Larsen CG, Adams W, Brown NM, McAsey CJ. Effect of Preoperative Dental Extraction on Postoperative Complications After Total Joint Arthroplasty. J Arthroplasty 2019; 34:2080-2084. [PMID: 31138503 DOI: 10.1016/j.arth.2019.04.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/27/2019] [Accepted: 04/25/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Poor dental hygiene has historically been considered a potential risk factor for infection in total joint arthroplasty (TJA), which has resulted in the common practice of requiring preoperative dental clearance and often results in dental extractions. However, the association between dental pathology and periprosthetic joint infection (PJI) has recently been called into question. METHODS A consecutive series of 2457 primary total hip and total knee arthroplasties were retrospectively reviewed. Documented dental evaluation was found in 1944 (79.1%) procedures, 223 (11.5%) of which had extraction of at least 1 tooth. No documented dental evaluation was found in 369 (15.0%) patients. RESULTS The overall complication rate was 3.87% with an overall PJI rate of 1.51%. There was no statistically significant association between a complication and procedure type, sex, preoperative dental evaluation or extraction, diabetes status, immunosuppression, malnutrition, or age. However, our sample demonstrated a higher complication rate among patients undergoing dental extraction as well as for those with diabetes and immunosuppressed patients. CONCLUSION Our findings suggest that routine formal dental clearance for all TJA patients may not be necessary. Additionally, patients with poor oral hygiene may not have elevated risk of postoperative PJI, and preoperative tooth extraction may represent an unnecessary step for patients undergoing elective TJA.
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Affiliation(s)
- Kevin A Sonn
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, IL
| | | | - William Adams
- Clinical Research Office Biostatistics Core, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Nicholas M Brown
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, IL
| | - Craig J McAsey
- Anderson Orthopaedic Research Institute, Department of Orthopaedic Surgery, Arlington, VA
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