Antibiotic Prophylaxis in Dental Procedures for Total Joint Replacement Patients

1. Doporučení ATB profylaxe u pacientů s TEP při stomatologických výkonech

2. Studie Infekce TEP 1,2-2% Hematogenní infekce 0,2-1,7% 4 studie – nepřímá evidence odontogenní IKN 0,03-0,1% XX – 6 studií není signifikantní rozdíl v redukci odontogenní IKN při profylaktickém podání ATB

3. Zhodnocení studií Není důkaz zda antibiotická profylaxe zubních výkonů má pozitivní nebo negativní vliv na výskyt hematogenní infekce kloubní náhrady po těchto výkonech

4. Bakteriémie Je možné infikovat implantát při bakteriémii? - na zvířecím modelu – jen při velmi vysoké dávce bakterií - člověk – při sepsi (>1000 CFU/ml) Kumulativní expozice / 1 měsíc 5376 min x 6 min při extrakci Incidence bakteriémie je denně velmi častá!! - čištění kartáčkem - 16-78% - čištění nití - 20-58% - žvýkání - 8-51% Trvání - < 20 min Kontcentrace v séru - < 10 na 4 Gunteroth WG, Am J Cardiol

5. Krevní ztráty u stomatologických výkonů American hearth association – expert opinion ¹ - krvácení zvyšuje riziko bakteriemie Lockhart ²: krvácení - 8x vyšší bakteriemie při plaku a zubním kameni Roberts ³: není vztah krvácení a bkteriemie ¹ Dajani et all. Clin Inf Dis, 1997, 25:1448-58 ² Lockhart et all. J Am Dent Assoc 2009, 140 (10): 1238-44 ³ Roberts Pediatr Cardiol 20 (3): 317-25 Závěr: není dostatek důkazů, že krvácení zvyšuje bakteriemii

6. Riziko odontogenní IKN u pacientů do dvou let po TEP Hansen et all 1996 ¹ joint age < 2Y 0,14/100 TEP/rok > 2Y 0,03/100 TEP/rok Deacon ²: joint age < 2Y 50% HIKN Uckay ³: 6101 THP/TKP > >5/7 HIKN > 2Y Huotari : 619 299 proth-yrs – late > 2Y 0,041%-0,107% – very late > 5Y HIKN narůstá ¹ Hansen et all JBJS – A 1996: 78(3) 458-71 ² Deacon et all JBJS – A 1996: 78(11) 1755-70 ³ Uckay et all J Infect 2009: 59(9) 337-45 Huotari et all 2015 Závěr: není dostatek důkazů, že je větší riziko hematogenní odontogenní infekce TEP do 2 let po implantaci

7. Pacienti se sníženou imunitou DM, RA, hemofilie, imunosupresivní léčba, psoriaza... Berbari ¹ : prospective case control: Není zvýšené riziko u nízko či vysokorizikových stomatologických výkonů • není evidence rostoucího rizika odontogenní IKN u pacientů se sníženou imunitou • i u těchto pacientů je denní bakteriemie vyšší než u stomatologického výkonu • vhodné nechat posouzení potřeby ATB terapie na interním specialistovi ² ¹ Berbari et all. Clin Inf Dis 2010 ² Sendi et all. JBJS

8. Historie doporučení ATB profylaxe u stamatologických výkonů u pacientů po totální klubní náhradě - Amerika

9. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints Evidence-based clinical practice guideline for dental practitioners—a report of the American Dental Association Council on Scientific Affairs Thomas P. Sollecito, DMD, FDS RCSEd, Elliot Abt, DDS, MS, MSc, Peter B. Lockhart, DDS, FDS RCSEd, FDS RCPS, Edmond Truelove, DDS, MSD, Thomas M. Paumier, DDS, Sharon L. Tracy, PhD Correspondence information about the author PhD Sharon L. Tracy, Malavika Tampi, MPH, Eugenio D. Beltrán-Aguilar, DMD, MPH, MS, DrPH, Julie Frantsve-Hawley, PhD Practical Implications and Conclusions The 2014 Panel made the following clinical recommendation: In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection. The practitioner and patient should consider possible clinical circumstances that may suggest the presence of a significant medical risk in providing dental care without antibiotic prophylaxis, as well as the known risks of frequent or widespread antibiotic use. As part of the evidence-based approach to care, this clinical recommendation should be integrated with the practitioner’s professional judgment and the patient’s needs and preferences Surgeons. dvisory statement: antibiotic prophylaxis for dental patients prophylactic cleaning of teeth or implants, if bleeding is expected. uP mended antibiotic prophylaxis for patients following a total knee high-risk dental procedures *** Same Lifetime, following aaos Same 2010 entists must consider *** he following dental procedures may cause bleeding or high levels of bacteria n n n S, prosthetic joint infections, aid subgingival placement of antibiotic fibres or strips; n type diabetes, cancer). initial placement of orthodontic bands; n intraligamentary injections of local anesthetic; n n 3. merican cademy of Orthopaedic Surgeons. nformation Statement 1033. a eferen es February 2009. ssociation and 1. a merican ental merican cademy of Orthopaedic nformation Statement 1033. a cademy of Orthopaedic Surgeons. merican 4. February 2009, revised June 2010. with total joint replacements. JADA 1997; 128 (7): 1004-1008. 5. ental ssociation. Canadian J Can Dent Assoc 2012; 78: c40_f. 2. a merican ental ssociation and merican cademy of Orthopaedic ssociation. Press release. 6. ental a merican vidence nsufficient to dvisory statement: antibiotic prophylaxis for dental patients Surgeons. ndergo eplacement Patients Who ecommend ntibiotics for Joint outine with total joint replacements. JADA 2003; 134 (7): 895-898. ental Procedures. Lydia Hall, Manager, Media elations. ecember 18, 2012. dated January 2013 ntibiotic Pro uP date on a P ental Patients hylaxis for d f W t h i P P a ollo ing otal Knee or lasty rthro A published in 2012 in the Journal of the high-risk dental procedures are necessary. However, in 2009, the n arti C le Canadian Dental Association raised questions about OS altered its position to include all patients who had undergone aa the recommendations that dentists are to follow when a total joint arthroplasty, without exception. i treating patients who have undergone a total knee or OS and aa n view of the new recommendations published by the d hip arthroplasty. ecember 2012, it would be prudent to consider the most in the ada Cephalexin or amoxicillin 2 g orally 1 hour before the dental procedure or clindamycin 600 mg orally 1 hour before the dental procedure, plates or screws. patients with orthopedic pins, ylaxis for ER n n ndications ). Only high-risk patients ll patients who have had ( or hip arthroplasty, in the two years following the surgery, when by the Canadian collaborated with the r History of aa ada 1997 DECEM ada 2012 odq aaos aaos 2009 2003 y 2012 * ntibiotic therapy ear and organization r OS) to publish a joint information statement, which was endorsed n emember that in 2003, the i ot including , and , cda cda 3 4 and aaos d d 5 and a a ada C b aaos 1 6 a a d ental r 2 ecommendations ** a merican i d their way of prescribing total arthroplasty prophylactic antibiotics for patients who have t procedures. plasty and require dental undergone total arthro- total arthroplasty Same total arthroplasty t the possibility of changing t wo years following wo years following a he types of patients concerned include: all patients in the two years following immunodepressed patients; patients with co-morbidities (haemophilia, including previous ssociation (C arthroplasty; a a i f a a ollowing merican cademy of Orthopaedic Surgeons a a * * * da d ental t he statement recom a t ssociation ( high-risk dental procedures a t Only high-risk patients Same joint infections. total arthroplasty linkage between dental procedures and prosthetic showing no cause and effect r o here is limited evidence ecommendations c tal Knee or Hip oncerning n n ada t rop H p a tients a rt ntibiotic e u Same r r a (topical antibiotics applied by the dentist) prior to a dental procedure r the 2003 recommendations. entists choosing to use antibiotic prophylaxis should follow d for cases of confirmed penicillin allergy with prosthetic joints must maintain good dental hygiene. establishing a link between deficient oral hygiene and prosthetic prevents prosthetic joint infection. Given the lack of reliable evidence p roplasty t Same Same Same - a i d a a d order to assure appropriate and safe dental treatment for the patient. d evaluating the situation and consult the orthopedist in each case in recent information statement presented at the end of the following summary, which casts doubt on the use of antibiotic prophylaxis prior , scaling, root planing and probing; a t all times, the dentist must exercise good judgment in properly i a in the blood: a dental extractions; pivot for endodontic posts and apical surgery; dental implant placement or replantation of avulsed teeth; periodontal procedures including surgery ) a here is no evidence that the application of topical antimicrobials joint infection, experts concur on the recommendation that patients *** and ** d r and ** to dental procedures. H

10. Doporučení ADA

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13. Literatura Berbari EF, Hanssen AD, Duffy MC, Ilstrup DM, Harmsen WS, Osmon DR. Risk factors for prosthetic joint infection: case control study. Clin Infect Dis 1998;27:1247 - Brause BD. Infections associated with prostehtic joints. Clin Rheum Dis 1986;12:523 - Ching DW, Gould IM, Rennie JA, Gibson PI. Prevention of late haematogenous infection in major prosthetic joints. J Antimicr ob Chemother 1989;23:676 - Dajani AS, Taubert KA, WilsonW, et al. Prevention of bacterial endocarditis: recommendations of the American Heart Association. From the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young. JAMA 1997;277:1794 - Jacobson JJ, Millard HD, Plezia R, Blankenship JR. Dental treatment and late prosthetic joint infections. Oral Surg Oral Med Oral Pathol 1986;61:413 - Jacobson JJ, Patel B, Asher G, Wolliscroft JO, Schaberg D. Oral Staphylococcus in elderly subjects with rheumatoid arthritis. J Am Geriatr Soc 1997;45:1 - Johnson DP, Bannister GG. The outcome of infected arthroplasty of the knee. J Bone Joint Surg Br 1986;68(2):289 - Murray RP, Bourne MH, Fitzgerald RH Jr. Metachronous infection in patients who have had more than one total joint arthroplasty. J Bone Joint Surg Am 1991;73(10):1469 - Poss R, Thornhill TS, Ewald FC, Thomas WH, Batte NJ, Sledge CB. Factors influencing the incidence and outcome of infection following total joint arthroplasty. Clin Orthop 1984;182:117 -