Analysis of Prosthetic Joint Infections Following Invasive Dental Procedures in England.
Analysis of Prosthetic Joint Infections Following Invasive Dental Procedures in England.
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DOI：
10.1001/jamanetworkopen.2021.42987
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发表时间：
2022-01-04
影响因子：
13.8
通讯作者：
Nicholl J
中科院分区：
文献类型：
--
作者：
Thornhill MH;Crum A;Rex S;Stone T;Campbell R;Bradburn M;Fibisan V;Lockhart PB;Springer B;Baddour LM;Nicholl J
在侵入性牙科手术（IDP）之前未接受抗生素预防的患者中，侵入性牙科手术（IDP）与晚期假体关节感染（LPJI）之间是否存在相关性？这项队列研究对9427例LPJI住院患者进行了研究，这些患者的牙科记录在入院前15个月内可用，没有证据表明IDP和LPJI之间存在时间关联。考虑到成本、药物不良反应风险以及与抗生素预防相关的促进抗生素耐药性的可能性，这些发现驳斥了在IDP之前对人工关节患者进行抗生素预防的建议。该队列研究评估了英国患者中侵入性牙科手术与随后的人工关节感染之间是否存在时间相关性。美国的牙科医生受到整形外科医生及其假体关节患者的压力，要求他们在侵入性牙科手术（IDP）之前提供抗生素预防，以降低晚期假体关节感染（LPJI）的风险。几十年来，这一直是一种常见的做法，尽管缺乏证据表明IDP和LPJI之间存在关联，缺乏抗生素预防功效的证据，提供抗生素预防的成本，以及药物不良反应的风险和促进抗生素耐药性的可能性。量化IDP和后续LPJI之间的任何时间关联。这项队列研究采用病例交叉和时间趋势设计，以检查IDP和LPJI之间的任何潜在关联。选择英格兰人口（5500万）是因为在英格兰从未推荐过抗生素预防来预防LPJI，因此IDP和LPJI之间的任何关联都将充分暴露。纳入了2011年12月25日至2017年3月31日期间因LPJI在英格兰医院住院的所有患者，并且这些患者的牙科记录可用。分析于2018年5月至2021年6月期间进行。接触IDP。主要结局是LPJI入院前3个月（病例期）与入院前12个月（对照期）的IDP发生率比较。共确定了9427例有牙科记录的LPJI住院患者（平均[SD]患者年龄，67.8 [13.1]岁），包括4897例（52.0%）男性和4529例（48.0%）女性。其中，2385例（25.3%）有髋关节假体，3168例（33.6%）有膝关节假体，259例（2.8%）有其他假体，3615例（38.4%）假体类型未知。IDP和随后的LPJI之间没有显著的时间关联。事实上，在LPJI之前的3个月内，IDP的发生率较低（发生率比，0.89; 95%CI，0.82-0.96; P = 0.002）。这些结果表明，没有理由在人工关节患者的IDP之前给予抗生素预防。
Is there an association between invasive dental procedures (IDP) and late prosthetic joint infections (LPJI) in patients who did not receive antibiotic prophylaxis prior to IDP? This cohort study of 9427 LPJI hospital admissions for which dental records were available from 15 months preceding admission found no evidence of a temporal association between IDP and LPJI. These findings refute recommendations to give antibiotic prophylaxis to patients with prosthetic joints prior to IDP, given the cost, adverse drug reaction risk, and potential for promoting antibiotic resistance associated with antibiotic prophylaxis. This cohort assesses whether there is a temporal association between invasive dental procedures and subsequent later prosthetic joint infection among patients in England. Dentists in the United States are under pressure from orthopedic surgeons and their patients with prosthetic joints to provide antibiotic prophylaxis before invasive dental procedures (IDP) to reduce the risk of late prosthetic joint infection (LPJI). This has been a common practice for decades, despite a lack of evidence for an association between IDP and LPJI, a lack of evidence of antibiotic prophylaxis efficacy, cost of providing antibiotic prophylaxis, and risk of both adverse drug reactions and the potential for promoting antibiotic resistance. To quantify any temporal association between IDP and subsequent LPJI. This cohort study used a case-crossover and time trend design to examine any potential association between IDP and LPJI. The population of England (55 million) was chosen because antibiotic prophylaxis has never been recommended to prevent LPJI in England, and any association between IDP and LPJI would therefore be fully exposed. All patients admitted to hospitals in England for LPJI from December 25, 2011, through March 31, 2017, and for whom dental records were available were included. Analyses were performed between May 2018 and June 2021. Exposure to IDP. The main outcome was the incidence of IDP in the 3 months before LPJI hospital admission (case period) compared with the incidence in the 12 months before that (control period). A total of 9427 LPJI hospital admissions with dental records (mean [SD] patient age, 67.8 [13.1] years) were identified, including 4897 (52.0%) men and 4529 (48.0%) women. Of these, 2385 (25.3%) had hip prosthetic joints, 3168 (33.6%) had knee prosthetic joints, 259 (2.8%) had other prosthetic joints, and 3615 (38.4%) had unknown prosthetic joint types. There was no significant temporal association between IDP and subsequent LPJI. Indeed, there was a lower incidence of IDP in the 3 months prior to LPJI (incidence rate ratio, 0.89; 95% CI, 0.82-0.96; P = .002). These findings suggest that there is no rationale to administer antibiotic prophylaxis before IDP in patients with prosthetic joints.
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影响因子：
39.3
作者：
Lacassin, F;Hoen, B;Briancon, S
通讯作者：
Briancon, S
影响因子：
5.3
作者：
Kurtz, Steven M.;Ong, Kevin L.;Lau, Edmund
通讯作者：
Lau, Edmund
DOI：
10.1302/0301-620x.66b4.6430907
发表时间：
1984-01-01
影响因子：
--
作者：
AINSCOW, DAP;DENHAM, RA
通讯作者：
DENHAM, RA
DOI：
10.14219/jada.archive.1985.0224
发表时间：
1985-01-01
影响因子：
3.9
作者：
JASPERS, MT;LITTLE, JW
通讯作者：
LITTLE, JW
影响因子：
1.6
作者：
Chen, Pei-Chun;Tung, Ying-Chang;Chu, Pao-Hsien
通讯作者：
Chu, Pao-Hsien