抗生素预防在拔牙、牙种植及牙周外科手术中的应用
Use of Antibiotic Prophylaxis for Tooth Extractions, Dental Implants, and Periodontal Surgical Procedures.
作者信息
Suda Katie J, Henschel Heather, Patel Ursula, Fitzpatrick Margaret A, Evans Charlesnika T
机构信息
Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital, Illinois.
Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago.
出版信息
Open Forum Infect Dis. 2017 Nov 15;5(1):ofx250. doi: 10.1093/ofid/ofx250. eCollection 2018 Jan.
BACKGROUND
Guidelines for antibiotics prior to dental procedures for patients with specific cardiac conditions and prosthetic joints have changed, reducing indications for antibiotic prophylaxis. In addition to guidelines focused on patient comorbidities, systematic reviews specific to dental extractions and implants support preprocedure antibiotics for all patients. However, data on dentist adherence to these recommendations are scarce.
METHODS
This was a cross-sectional study of veterans undergoing tooth extractions, dental implants, and periodontal procedures. Patients receiving antibiotics for oral or nonoral infections were excluded. Data were collected through manual review of the health record.
RESULTS
Of 183 veterans (mean age, 62 years; 94.5% male) undergoing the included procedures, 82.5% received antibiotic prophylaxis (mean duration, 7.1 ± 1.6 days). Amoxicillin (71.3% of antibiotics) and clindamycin (23.8%) were prescribed most frequently; 44.7% of patients prescribed clindamycin were not labeled as penicillin allergic. Of those who received prophylaxis, 92.1% received postprocedure antibiotics only, 2.6% received preprocedural antibiotics only, and 5.3% received pre- and postprocedure antibiotics. When prophylaxis was indicated, 87.3% of patients received an antibiotic. However, 84.9% received postprocedure antibiotics when preprocedure administration was indicated. While the majority of antibiotics were indicated, only 8.2% of patients received antibiotics appropriately. The primary reason was secondary to prolonged duration. Three months postprocedure, there were no occurrences of infection, infective endocarditis, prosthetic joint infections, or postprocedure oral infections.
CONCLUSION
The majority of patients undergoing a dental procedure received antibiotic prophylaxis as indicated. Although patients for whom antibiotic prophylaxis was indicated should have received a single preprocedure dose, most antibiotics were prescribed postprocedure. Dental stewardship efforts should ensure appropriate antibiotic timing, indication, and duration.
背景
针对患有特定心脏疾病和人工关节的患者，牙科手术前使用抗生素的指南已经发生变化，减少了抗生素预防的适应症。除了关注患者合并症的指南外，针对拔牙和种植牙的系统评价支持对所有患者进行术前抗生素治疗。然而，关于牙医遵守这些建议的数据很少。
方法
这是一项对接受拔牙、种植牙和牙周手术的退伍军人进行的横断面研究。排除因口腔或非口腔感染接受抗生素治疗的患者。通过人工查阅健康记录收集数据。
结果
在接受纳入手术的183名退伍军人（平均年龄62岁；94.5%为男性）中，82.5%接受了抗生素预防（平均持续时间7.1±1.6天）。阿莫西林（占抗生素的71.3%）和克林霉素（23.8%）是最常开具的药物；开具克林霉素的患者中有44.7%未被标记为对青霉素过敏。在接受预防的患者中，92.1%仅在术后接受抗生素治疗，2.6%仅在术前接受抗生素治疗,5.3%在术前和术后均接受抗生素治疗。当需要进行预防时，87.3%的患者接受了抗生素治疗。然而，当术前需要使用抗生素时，仍有84.9%的患者在术后接受了抗生素治疗。虽然大多数抗生素是有指征使用的，但只有8.2%的患者接受了适当的抗生素治疗。主要原因是使用时间过长。术后三个月，未发生感染、感染性心内膜炎、人工关节感染或术后口腔感染。
结论
大多数接受牙科手术的患者按指征接受了抗生素预防。尽管需要进行抗生素预防的患者应在术前接受单次剂量的抗生素治疗，但大多数抗生素是在术后开具的。牙科管理工作应确保抗生素的使用时间、指征和持续时间适当。
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