OrthoCarolina Hip and Knee Center and Atrium Musculoskeletal Institute, Charlotte, NC.
Division of Infectious Diseases, Departments of Medicine and Cardiovascular Disease, Mayo Clinic College of Medicine, Rochester, MN.
J Arthroplasty. 2022 Jul;37(7):1223-1226. doi: 10.1016/j.arth.2022.02.014. Epub 2022 Feb 11.
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.
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.
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.
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.
在美国，牙医在进行侵入性牙科操作（IDP）前建议使用抗生素预防（AP），以预防已接受人工关节置换术的患者发生晚期人工关节周围感染（LPJI），尽管 IDP 与 LPJI 之间缺乏因果关系的证据，且 AP 的疗效也缺乏证据。
最近的一项研究量化了英国 LPJI 住院患者在发生 LPJI 前 15 个月的 IDP 发生率，其中有牙科记录。病例交叉分析比较了 LPJI 入院前 3 个月的 IDP 发生率与前 12 个月的 IDP 发生率。选择英国人群是因为其指南不建议使用 AP，并且 IDP 与 LPJI 之间的任何关系都应充分暴露。
IDP 与 LPJI 之间未发现显著的正相关关系。实际上，LPJI 入院前 3 个月的 IDP 发生率低于前 12 个月。
在 IDP 与 LPJI 之间未发现显著的正相关关系的情况下，没有理由在接受人工关节置换术的患者中在 IDP 前使用 AP，尤其是考虑到 AP 的成本和不便、药物不良反应的风险以及不必要的 AP 使用可能促进抗生素耐药性的问题。这些结果应使矫形外科医生及其患者放心，认为对接受人工关节置换术的患者的口腔护理应侧重于保持良好的口腔卫生，而不是推荐对 IDP 使用 AP。此外，这也应使其他不建议使用 AP 的国家的医生放心，他们的指导意见是足够的。
