Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-05-12T12:31:20.569Z Has data issue: false hasContentIssue false
  • English
  • Français

Antibiotic prophylaxis for Dental Patients with Joint Prostheses? A Decision Analysis

Published online by Cambridge University Press:  10 March 2009

Jed J Jacobson ,
Stuart Schweitzer ,
David J. DePorter  and
J. Jack Lee
Jed J Jacobson
Affiliation:
The University of Michigan School of Dentistry
Stuart Schweitzer
Affiliation:
UCLA School of Public Health
David J. DePorter
Affiliation:
UCLA School of Dentistry
J. Jack Lee
Affiliation:
UCLA Center for Health Sciences
Get access Rights & Permissions [Opens in a new window]

Abstract

A decision analysis was performed to assess the risks, costs, and effects of no prophylaxis, oral penicillin, and cephalexin regimens currently being debated for dental patients at risk for late prosthetic joint infection (LPJI). The analysis suggests that there is a very small risk of LPJI (29.3 cases per 106 dental visits), which is outweighed by a greater risk of death with an oral penicillin strategy than with a “no prophylaxis” strategy (2.31:1.93). An oral cephalosporin appears to spare life and limb but does so at an extremely high cost. Over $500,000 must be spent to spare one year of life, while $480,000 needs to be spent to prevent one case of LPJI. Some individual dental patients may still be at a much greater risk for LPJI than others. However, from the evidence to date, routine predental antibiotic prophylaxis for all prosthetic joint patients is a very expensive preventive strategy and is not cost-effective. However, clinical experience suggests that antibiotic prophylaxis may be appropriate in some situations.

Type
Special Section: Assessing the Technology of Dentistry, Part II
Information
International Journal of Technology Assessment in Health Care , Volume 6 , Issue 4 , October 1990 , pp. 569 - 587
Copyright
Copyright © Cambridge University Press 1990

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahlberg, A., Carlsson, A. & Lindberg, L.Hematogenous infection in total joint replacement. Clinical Orthopaedics and Related Research, 1978, 137, 69–75.Google Scholar
Ahlberg, A. & Lunden, A.Secondary operations after knee joint replacement. Clinical Orthopaedics and Related Research, 1981, 156, 170–74.CrossRefGoogle Scholar
Aincow, D. A. & Denham, R. A.The risk of haematogenous infection in total joint replacements. Journal of Bone and Joint Surgery, 1984, 66, 580–82.Google Scholar
American Dental Association, Bureau of Economic Research and Statistics. The Elderly: a socioeconomic profile. ADA Annual Reports and Resolutions 1977, 117 (suppl. rep. 1), 330–36.Google Scholar
Bannon, J. A., Foradori, G. T. & Schrogie, J. J.The use of cefadoxil suspension in children. Journal of Antimicrobial Chemotherapy, 1982, 10 (suppl. B), 153.CrossRefGoogle ScholarPubMed
Barnes, B. An overview of the treatment of end-stage renal disease and a consideration of some of the consequences. In Bunker, J., Barnes, B. & Mosteller, F. (eds.), Costs, risks, and benefits of surgery, Oxford: Oxford University Press, 1977, 325–41.Google Scholar
Bengston, S., Blomgren, G., Knutson, K. et al. Hematogenous infection after knee arthroplasty. Acta Orthopaedica Scandinavica, 1987, 58, 529–34.Google Scholar
Bliss, D. & McBride, G.Infected total knee arthroplasties. Clinical Orthopaedics and Related Research, 1985, 199, 207–14.CrossRefGoogle Scholar
Buchholz, H., Elson, R., Engelbrecht, E. et al. Management of deep infection of total hip replacement. Journal of Bone and Joint Surgery, 1981, 63-B, 342–53.Google ScholarPubMed
Burt, R. A.A review of the drug events reported by 12,917 patients treated with cephalexin. Postgraduate Medicine Journal, 1983, 59, 47–50.Google ScholarPubMed
Carlsson, A., Lidgren, L. & Lindberg, L.Prophylactic antibiotics against early and late deep infections after total hip replacements. Acta Orthopaedica Scandinavica, 1977, 48, 405–10.CrossRefGoogle ScholarPubMed
Chancey, R., Morris, A., Conner, R. et al. Studies of streptococcal prophylaxis: Comparison of oral penicillin and benzathine penicillin. American Journal of Medical Sciences, 1955, 229, 119–27.CrossRefGoogle ScholarPubMed
Clemens, J. D. & Ransohoff, D. F.A quantitative assessment of pre-dental antibiotic prophylaxis for patients with mitral-valve prolapse. Journal of Chronic Diseases, 1984, 37, 531–44.CrossRefGoogle ScholarPubMed
Cobe, H. M.Transient bacteremias. Oral Surgery, Oral Medicine, Oral Pathology, 1954, 7, 609.CrossRefGoogle Scholar
Cruess, R. L., Bickel, W. S. & Von, Kessler K. L. C.Infections in total hips secondary to a primary source elsewhere. Clinical Orthopaedics and Related Research, 1975, 106, 99–101.CrossRefGoogle Scholar
D'Ambrosia, R., Shoji, H. & Heater, R.Secondarily infected total joint replacements by hematogenous spread. Journal of Bone and Joint Surgery, 1976, 58-A, 450–53.CrossRefGoogle ScholarPubMed
Downes, E. M.Late infection after total hip replacement. Journal of Bone and Joint Surgery, 1977, 59, 44.Google ScholarPubMed
Durack, D. T. Prophylaxis of infective endocarditis. In Mandell, G. L., Douglas, R. G. Jr & Bennett, T. E. (eds.), Principles and Practice of Infectious Diseases, New York: John Wiley, 1979.Google Scholar
Everett, E. D. & Hirschmann, J. V.Transient bacteremia and endocarditis prophylaxis: A review. Medicine, 1977, 56, 61.CrossRefGoogle ScholarPubMed
Fitzgerald, R., Nolan, D., Ilstrup, D. et al. Deep wound sepsis following total hip arthroplasty. Journal of Bone and Joint Surgery, 1977, 59-A, 847–55.CrossRefGoogle ScholarPubMed
Gold, J., McKee, J. & Zip, P.Experience with cefazolin: An overall summary of pharmacologic and clinical trials in man. Journal of Infectious Diseases, 1973, 128 (suppl.), 5414–21.CrossRefGoogle ScholarPubMed
Grogan, T., Dorey, FRollins, J. & Amstutz, H.Deep sepsis following total knee arthroplasty. Journal of Bone and Joint Surgery, 1986, 68-A, 226–34.CrossRefGoogle ScholarPubMed
Hofammann, D. Y., Keeling, J. W. & Meyer, R. D.Total hip arthroplasty. Southern Medical Journal, 1986, 79, 1252–55.CrossRefGoogle ScholarPubMed
Hori, R. Y., Lewis, J. L., Zimmerman, J. R. & Compere, C. L.The number of total joint replacements in the United States. Clinical Orthopedics, 1978, 132, 46–52.Google Scholar
Hunter, J., Zoma, A., Scullion, J. et al. The geometric knee replacement in polyarthritis. Journal of Bone Joint Surgery, 1982, 64, 95–98.Google ScholarPubMed
Idsoe, O., Guthe, T., Willcox, R. & DeWeck, A.Nature and extent of penicillin side-reactions, with particular reference to fatalities from anaphylactic shock. Bulletin of the World Health Organization, 1968, 38, 159–88.Google ScholarPubMed
Insall, J., Thompson, F. & Brause, B.Two-stage reimplantation for the salvage of infected total knee arthroplasty. Journal of Bone and Joint Surgery, 1983, 65-A, 1087–98.CrossRefGoogle ScholarPubMed
Irvine, R., Johson, B. & Amstutz, H.The relationship of genito-urinary procedures and deep sepsis after total hip replacement. Surgery, Gynecology, Obstetrics, 1975, 139, 701–06.Google Scholar
Jacobsen, P. & Murray, W.Prophylactic coverage of dental patients with artificial joints: A retrospective analysis of thirty-three infections in hip prostheses. Oral Surgery, Oral Medicine, Oral Pathology, 1980, 50, 130–33.CrossRefGoogle ScholarPubMed
Jacobson, J. & Matthews, L.Bacteria isolated from late prosthetic joint infections: Dental treatment and chemoprophylaxis. Oral Surgery, Oral Medicine, Oral Pathology, 1987, 63, 122–26.CrossRefGoogle ScholarPubMed
Jacobson, J.Millard, H., Plezia, R. & Blankenship, J.Dental treatment and late prosthetic joint infections. Oral Surgery, Oral Medicine, Oral Pathology, 1986, 61, 413–17.CrossRefGoogle ScholarPubMed
Jaspers, M. T. & Little, J. W.Prophylactic antibiotic coverage in patients with total arthroplasty: Current practice. Journal of the American Dental Association, 1987, 111, 943–48.CrossRefGoogle Scholar
Johnson, D. P. & Bannister, G. C.The outcome of infected arthroplasty of the knee. Journal of Bone and Joint Surgery, 1986, 68B, 289–91.Google ScholarPubMed
Leinbach, I. & Barlow, F.700 total hip replacements. Clinical Orthopaedics and Related Research, 1973, 95, 174–92.Google Scholar
Lindquist, C. & Slatis, P.Dental bacteremia – a neglected cause of orthoplasty infections? Acta Orthopaedica Scandinavica, 1985, 56, 506–08.CrossRefGoogle Scholar
Little, J.The need for antibiotic coverage for dental treatment of patients with joint replacements. Oral Surgery, Oral Medicine, Oral Pathology, 1983, 55, 20–23.CrossRefGoogle ScholarPubMed
Loesch, W. J. Indigenous human flora and bacteremia. In Kaplan, E. L. & Taranta, A. V. (eds.), Infective Endocarditis, an American Heart Association Symposium, Dallas: American Heart Association, 1977.Google Scholar
Maderazo, E. G., Judson, S. & Pasuernak, H.Late infections of total joint protheses. Clinical Orthopaedics and Related Research, 1988, 229, 131–42.CrossRefGoogle Scholar
Moellering, R. & Swartz, M.The newer cephalosporins. New England Journal of Medicine, 1976, 294, 24–28.CrossRefGoogle ScholarPubMed
Nelson, C., Evarts, C., Andrish, J. & Marks, K.Results of total infected hip replacement arthroplasty. Clinical Orthopaedics and Related Research, 1980, 147, 258–61.CrossRefGoogle Scholar
Nelson, J. P., Glassburn, A. R., Talbott, R. D. & McElhinney, J. P.The effect of previous surgery, operating room environment, and preventive antibiotics on post-operative infection following total hip arthroplasty. Clinical Orthopaedics and Related Research, 1980, 147, 167–69.CrossRefGoogle Scholar
Oral Health of US. Adults. U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health Publication No. 87–2868, Aug. 1987.Google Scholar
Persson, U., Montgomery, F., Carlsson, A. et al. How far does prophylaxis against infection in total joint replacement offset its cost? British Medical Journal, 1988, 296, 99–102.CrossRefGoogle ScholarPubMed
Petty, W., Bryan, R., Coventry, M. & Peterson, L.Infection after total knee arthroplasty. Orthopaedic Clinics of North America, 1975, 6, 1005–14.CrossRefGoogle ScholarPubMed
Petz, L.Immunologic reactions of humans to cephalosporins. Postgraduate Medicine Journal, 1971, 47 (suppl.), 64–69.Google ScholarPubMed
Prevention of bacterial endocarditis. A statement for health professionals by the Committee on Rheumatic Fever and Infective Endocarditis of the Council on Cardiovascular Disease in the Young. Special Report. Circulation, 1984, 70, 1223A–1127A.Google Scholar
Rubin, R., Salvati, E. & Lewis, R.Infected total hip replacement after dental procedures. Oral Surgery, Oral Medicine, Oral Pathology, 1976, 41, 18–22.CrossRefGoogle ScholarPubMed
Rudolph, A. & Price, E.Penicillin reactions among patients in venereal disease clinics: a national survey. Journal of the American Medical Association, 1973, 223, 449–501.Google ScholarPubMed
Schurman, D. J., Apteker, R. G. & Burton, D. S.Infection in total knee joint replacement, secondary to tooth abscess. Western Journal of Medicine, 1976, 125, 226–27.Google ScholarPubMed
Schweitzer, S. & Scalzi, C. The cost-effectiveness of bone marrow transplant therapy and its policy implications. OTA, U.S. Congress, The implications of cost-effectiveness analysis of medical technology. GPO stock No. 052–003–00765–7. Washington, D.C.: U.S. Government Printing Office, 1980.Google Scholar
Sheppeard, H., Cleak, D., Ward, D. & O'Conner, B.A review of early morbidity and mortality in elderly patients following Charnley total hip replacement. Archives of Orthopaedic and Traumatic Surgery, 1980, 97, 243–48.CrossRefGoogle Scholar
Stinchfield, F., Bigliani, L., Neu, H. et al. Late hematogenous infection of total joint replacement. Journal of Bone and Joint Surgery, 1980, 62-A, 1345–50.CrossRefGoogle ScholarPubMed
Strazzeri, J. C. & Anzel, S.Infected total hip orthoplasty due to Actinomyces israel: After dental extraction. Clinical Orthopaedics and Related Research, 1986, 210, 128–31.CrossRefGoogle Scholar
Tompkins, R., Burnes, D. & Cable, W.An analysis of the cost-effectiveness of pharyngitis management and acute rheumatic fever prevention. Annals of Internal Medicine, 1977, 86, 481–92.CrossRefGoogle ScholarPubMed
Walker, R. & Schurman, D.Management of infected total knee arthroplasties. Clinical Orthopaedics and Related Research, 1984, 186, 81–89.CrossRefGoogle Scholar
Weinstein, L. & Kaplan, K.The cephalosporins: Microbiologic, chemical, and pharmacological properties and use in chemotherapy of infection. Annals of Internal Medicine, 1970, 72, 729–39.CrossRefGoogle ScholarPubMed
Weinstein, L. & Weinstein, A. J.The pathophysiology and pathoanatomy of reactions to antimicrobial agents. Advances in Internal Medicine, 1974, 19, 109–34.Google ScholarPubMed
Weinstein, M., Fineberg, H., Elstein, A. et al. Clinical Decision analysis. Philadelphia: W. B. Saunders, 1980.Google Scholar
Weinstein, M., Pliskin, J. & Stason, W. Coronary artery bypass surgery: decision and policy analysis. In Bunker, J., Barnes, B. & Mosteller, F. (eds.), Costs, risks, and benefits of surgery. Oxford: Oxford University Press, 1977, 325–41.Google Scholar
Wroblewski, B. & del, Sel H.Urethral instrumentation and deep sepsis in total hip replacement. Clinical Orthopaedics and Related Research, 1980, 146, 209–12.CrossRefGoogle Scholar