Prosthetic-Joint Infections Not Related to Invasive Dental Procedures

By Linda Carroll

January 21, 2022

NEW YORK (Reuters Health) - Patients with prosthetic joints do not need antibiotics prior to an invasive dental procedure to prevent infections, a new study from the UK suggests.

Dentists in the U.S. are under pressure from orthopedic surgeons and their patients with prosthetic joints to provide antibiotic prophylaxis before invasive dental procedures, and this has been common practice for decades, researchers note in JAMA Network Open

However, there is little evidence for a link between such procedures and late prosthetic-joint infections and for the value of using antibiotic prophylaxis in this setting, add Dr. Martin Thornhill of the University of School of Clinical Dentistry in Sheffield, UK, and colleagues.

To investigate, the researchers conducted a cohort study using national data from the Hospital Episode Statistics database of the UK's National Health Service (NHS) along with information from the NHS Business Services Authority, which maintains dental records for all patients receiving NHS dental treatment in England. Dentists working in the English NHS have been required to record dental extractions, scalings, and endodontic procedures since April 2008.

The study's control group included courses of treatment restricted to simple dental examinations with or without radiographs. The researchers note that "previous studies have shown that more than 90% of distant site infections associated with invasive dental procedures occur within three months, and this period is used widely to define distant site infections associated with invasive dental procedures."

Between 2011 and 2017, more than 23,000 patients were admitted to hospitals with late prosthetic-joint infections (LPJI), 9,427 of whom had dental records available. The analysis focused on the latter group (mean age, 68; 52% men).

A quarter of the patients had hip replacements, and a third had knee replacements. The remaining patients had other or unknown joints replaced. Among all patients with LPJI, in-hospital mortality was 3.7%, while it was 2.2% among those with dental records available.

The types of bacteria involved in the LPJI were recorded for 46.0% of the patients with dental data, with 53% staphylococci, 9% oral streptococci, 5% other streptococci, 20% other organisms and 13% mixed infections.

In both the control group and the group that had invasive dental procedures there was no significant increase in invasive dental procedures (IDP) in the one to three months prior to admission for LPJI, the researchers found.

In fact, among the 9,427 patients, the monthly incidences of invasive and noninvasive dental procedures, respectively, during the 15 months before LPJI hospital admission were similar.

"The findings of this cohort study suggest that, in the absence of any increase in IDP prior to LPJI, there is no evidence to support a positive association between IDP and LPJI or the practice of administering antibiotic prophylaxis to patients with prosthetic joints undergoing IDP," the researchers conclude.

"The continuing use of antibiotic prophylaxis represents a large and unnecessary financial burden on individuals and the health care system as well as an unnecessary risk to patients, from adverse drug reactions, and society, owing to the potential development of antibiotic resistant bacteria, and should cease," they say.

Experts welcomed the new study.

Even though this is not the "very best level of evidence" - in other words, it's not a randomized controlled trial - "it's very good evidence and it's compelling," said Dr. Bernard Costello, a professor of oral and maxillofacial surgery and dean of the University of Pittsburgh's School of Dental Medicine, in Pennsylvania.

It's important to disseminate this information to both dentists and doctors, Dr. Costello told Reuters Health by email.

"Prescribing antibiotics unnecessarily has consequences," he added. "This data is very important."

The practice of treating patients with antibiotics to prevent prosthetic joint infections is not supported by data, said Dr. Sanjay Jain, an infectious disease specialist and a professor of pediatrics at Johns Hopkins Medicine, in Baltimore, Maryland.

"I'm happy this study came out," Dr. Jain told Reuters Health by email. "It's really good to see a study showing conclusively that antibiotics aren't necessary."

Dr. Thornhill did not respond to requests for comment.

SOURCE: JAMA Network Open, online January 19, 2022.