Lockhart Peter B, Brennan Michael T, Fox Philip C, Norton H James, Jernigan Daniel B, Strausbaugh Larry J
Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, 28232, USA.
Clin Infect Dis. 2002 Jun 15;34(12):1621-6. doi: 10.1086/340619. Epub 2002 May 23.
There is debate concerning use of antibiotic prophylaxis before invasive dental procedures for patients at risk of acquiring distant site infection (DSI). We determined the opinions and practices of infectious disease consultants (IDCs) regarding antimicrobial prophylaxis to prevent DSIs that result from invasive dental procedures by conducting a survey of the 797 members of the Infectious Diseases Society of America Emerging Infections Network (477 members [60%] responded). Ninety percent of respondents closely follow the American Heart Association guidelines for antibiotic prophylaxis for patients with valvular heart disease who undergo invasive dental procedures. In contrast, few IDCs recommend prophylaxis for patients with lupus erythematosus, poorly controlled diabetes mellitus, dialysis catheters or shunts, cardiac pacemakers, or ventriculoperitoneal shunts. Twenty-five percent to forty percent of respondents recommended prophylaxis for prosthetic vascular grafts, orthopedic implants, or chemotherapy-induced neutropenia. We conclude that IDCs differ considerably in their assessment of the need for prophylaxis for patients who have noncardiac risk factors for DSI. These differences underscore the need for definitive studies to delineate appropriate candidates for antimicrobial prophylaxis in dental practice.
对于有发生远处部位感染（DSI）风险的患者，在进行侵入性牙科操作前使用抗生素预防措施存在争议。我们通过对美国传染病学会新发感染网络的797名成员进行调查（477名成员[60%]做出回应），确定了传染病顾问（IDCs）对于预防因侵入性牙科操作导致的DSI的抗菌预防措施的意见和做法。90%的受访者严格遵循美国心脏协会针对接受侵入性牙科操作的瓣膜性心脏病患者的抗生素预防指南。相比之下，很少有IDCs建议对红斑狼疮、控制不佳的糖尿病、透析导管或分流器、心脏起搏器或脑室腹腔分流器患者进行预防。25%至40%的受访者建议对人工血管移植物、骨科植入物或化疗引起的中性粒细胞减少症患者进行预防。我们得出结论，IDCs在评估有DSI非心脏危险因素的患者的预防需求方面存在很大差异。这些差异凸显了进行确定性研究以确定牙科实践中抗菌预防的合适人选的必要性。
