Prophylactic coverage of dental patients with artificial joints: a retrospective analysis of thirty-three infections in hip prostheses.

Persons with total joint prostheses theoretically risk infection from the transient bacteremia that may accompany dental treatment, and the literature suggests that these patients be treated prophylactically with antibiotics. Effective prophylaxis requires that the most common infecting organisms be identified and tested for drug sensitivity. We reviewed thirty-three cases of infected hips out of a total of 1,855 hip prosthesis placements. The infections were classified as early (less than 6 months after placement) or late (greater than 6 months after placement). In the patients studied, the risk of infection associated with dental procedures was extremely low (0.05 percent). Staphylococcus aureus was the organism most often isolated from the infected hips, and its incidence was twice as high in the late as in the early infections. Based on the drug sensitivities of the most common infecting organisms, the recommended drugs of choice for prophylactic treatment of dental patients with artificial joints are erythromycin, clindamycin, or a penase-resistant penicillin.