Credentials of Corresponding Author
Name of Faculty Advisor
Bamidele Tayo and Nallely Mora
Do prophylactic antibiotics prior to dental procedures reduce the incidence of prosthetic joint infections (PJIs) in patients greater than 18 years of age compared to patients who do not receive prophylaxis. There is conflicting data regarding the role of antibiotic prophylaxis prior to dental procedures to prevent prosthetic joint infections.
In this systematic review and meta-analysis, we attempt to determine whether prophylactic antibiotics prior to dental procedures reduces the incidence of prosthetic joint infections (PJIs) in patients greater than 18 years of age compared to patients who do not receive prophylaxis. Such information could be helpful in preventing PJIs if there is evidence of their benefit, or helpful from an antibiotic stewardship standpoint if there is no evidence of benefit.
A systematic review was performed on the available literature of studies evaluating prosthetic joint infections after the dental procedure as well as studies comparing antibiotic prophylaxis vs no prophylaxis regarding the risk/odds of prosthetic joint infection. The literature search period had no limits. Meta-analysis was performed on the studies including the specified exposure and outcome variables with a pooled odds ratio (OR) or estimates.
Results of literature search
A total of 1852 journal articles were reviewed. Eleven articles were included in the qualitative analysis and only 2 were included in the meta-analysis. The pooled OR was 0.99 (95% CI 0.65, 1.52) indicating no change in odds of prosthetic joint infection with antibiotic prophylaxis prior to the dental procedure. Heterogeneity could not be fully evaluated given the limited studies. The systematic review revealed little evidence of dental procedures being a major cause of prosthetic joint infections or any benefit of antibiotic prophylaxis in preventing these infections. There is limited data on the effectiveness of antibiotic prophylaxis in preventing prosthetic joint infections, but the available data does not show a significant decrease in infections in people who took antibiotics prior to dental procedures.
Synthesis of evidence
Our study represents the first meta-analysis and systematic review analyzing the effect of antibiotic prophylaxis prior to dental procedures in patients with prosthetic joints. Immediately apparent is the lack of high-quality data in this area. There have been no randomized controlled trials to evaluate the efficacy of prophylactic antibiotics prior to dental treatment at preventing PJI.
Implications for practice
The available data is limited but it does not suggest that antibiotic prophylaxis is effective in preventing prosthetic joint infections in patients undergoing dental procedures. More studies are required to evaluate this question, but there is not enough available evidence to recommend antibiotic prophylaxis prior to dental procedures in patients with prosthetic joints at this time.
Prophylactic Antibiotics prior to Dental Procedures in Adults with Joint Prostheses: A Systematic Review and Meta-Analysis