Rademacher Willem M H, Walenkamp Geert H I M, Moojen Dirk Jan F, Hendriks Johannes G E, Goedendorp Theo A, Rozema Frederik R
a Department of Oral Medicine , Academic Centre for Dentistry Amsterdam (ACTA).
b Department of Orthopedic Surgery and Research Institute CAPHRI , Maastricht University Medical Centre , Maastricht.
Acta Orthop. 2017 Oct;88(5):568-574. doi: 10.1080/17453674.2017.1340041. Epub 2017 Jun 22.
Background and purpose - To minimize the risk of hematogenous periprosthetic joint infection (HPJI), international and Dutch guidelines recommended antibiotic prophylaxis prior to dental procedures. Unclear definitions and contradictory recommendations in these guidelines have led to unnecessary antibiotic prescriptions. To formulate new guidelines, a joint committee of the Dutch Orthopaedic and Dental Societies conducted a systematic literature review to answer the following question: can antibiotic prophylaxis be recommended for patients (with joint prostheses) undergoing dental procedures in order to prevent dental HPJI? Methods - The Medline, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs), reviews, and observational studies up to July 2015. Studies were included if they involved patients with joint implants undergoing dental procedures, and either considered HPJI as an outcome measure or described a correlation between HPJI and prophylactic antibiotics. A guideline was formulated using the GRADE method and AGREE II guidelines. Results - 9 studies were included in this systematic review. All were rated "very low quality of evidence". Additional literature was therefore consulted to address clinical questions that provide further insight into pathophysiology and risk factors. The 9 studies did not provide evidence that use of antibiotic prophylaxis reduces the incidence of dental HPJI, and the additional literature supported the conclusion that antibiotic prophylaxis should be discouraged in dental procedures. Interpretation - Prophylactic antibiotics in order to prevent dental HPJI should not be prescribed to patients with a normal or an impaired immune system function. Patients are recommended to maintain good oral hygiene and visit the dentist regularly.
背景与目的——为将血源性人工关节感染（HPJI）的风险降至最低，国际和荷兰指南建议在牙科手术前进行抗生素预防。这些指南中定义不明确且建议相互矛盾，导致了不必要的抗生素处方。为制定新的指南，荷兰骨科和牙科协会联合委员会进行了一项系统的文献综述，以回答以下问题：对于接受牙科手术的（有关节假体的）患者，是否可以推荐使用抗生素预防以防止牙科HPJI？方法——检索了Medline、Embase和Cochrane数据库，查找截至2015年7月的随机对照试验（RCT）、综述和观察性研究。如果研究涉及接受牙科手术的关节植入患者，并且将HPJI作为结局指标或描述了HPJI与预防性抗生素之间的相关性，则纳入研究。使用GRADE方法和AGREE II指南制定了一项指南。结果——本系统综述纳入了9项研究。所有研究均被评为“证据质量极低”。因此，查阅了更多文献以解决能进一步深入了解病理生理学和危险因素的临床问题。这9项研究没有提供证据表明使用抗生素预防可降低牙科HPJI的发生率，更多文献支持在牙科手术中不应鼓励使用抗生素预防的结论。解读——对于免疫系统功能正常或受损的患者，不应开具预防性抗生素以预防牙科HPJI。建议患者保持良好的口腔卫生并定期看牙医。
