[Antibiotic prophylaxis in patients with joint prostheses]

Area of Science:

• Orthopedics
• Infectious Diseases
• Dentistry

Background:

• Patients with joint prostheses are at risk of periprosthetic joint infection (PJI).
• Dental procedures can potentially lead to hematogenous seeding of bacteria to prosthetic joints.
• The necessity of antibiotic prophylaxis for dental procedures in this population remains debated.

Purpose of the Study:

• To formulate a new Dutch guideline on antibiotic prophylaxis for dental procedures in patients with joint prostheses.
• To answer the research question: Is antibiotic prophylaxis indicated in patients with a joint prosthesis who undergo dental procedures?

Main Methods:

• A systematic literature review was conducted using the GRADE/AGREE II method to assess evidence strength.
• The review included studies on dental procedures, hematogenous PJI, and prophylactic antibiotic use.
• A supplementary literature review explored pathophysiology, risk factors, and risk interventions for PJI.

Main Results:

• Included studies found no conclusive evidence that antibiotic prophylaxis reduces the incidence of dental hematogenous PJI.
• The supplementary review also supported the conclusion that antibiotic prophylaxis is not beneficial for dental procedures.

Conclusions:

• Antibiotic prophylaxis is not indicated for patients with joint prostheses undergoing dental procedures.
• Current evidence suggests discouraging the use of antibiotic prophylaxis in this clinical scenario.