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.
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.
J Orthop Sci. 2024 Jul;29(4):1145-1148. doi: 10.1016/j.jos.2023.07.017. Epub 2023 Aug 3.
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.
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.
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.
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.
尽管人们已经认识到牙科手术作为菌血症的一个原因存在风险，但关于牙科手术与晚期人工关节周围感染（LPJI）之间关联的证据却很少。我们旨在确定牙科手术是否与 LPJI 的风险增加有关。
该研究采用病例交叉设计，利用日本的一个大型理赔数据库进行。我们确定了在 2014 年 4 月至 2021 年 9 月期间接受过牙科手术并因 LPJI 住院的成年患者。在病例期（1-4 周）评估牙科手术暴露情况，病例期之前有两个对照期（9-12 周和 17-20 周）。采用条件逻辑回归模型计算病例期与两个对照期相比 LPJI 与牙科手术相关的比值比（OR）和 95%置信区间（CI）。
共纳入 241 例 LPJI 患者进行病例交叉研究。在危险期间，46 例患者（19.1%）至少进行了一次牙科手术，75 例患者（31.1%）在对照期间进行了牙科手术。牙科手术与 LPJI 的 OR 为 0.96（95%CI，0.61-1.53；p=0.88）。在包括是否包括抗生素预防措施的牙科手术分层等几项敏感性分析中，结果都是稳健的。
本研究表明，牙科手术与 LPJI 的风险增加无关，这将对牙科手术前抗生素预防措施的建议提出质疑。
