Antibiotic prophylaxis is not indicated prior to dental procedures for prevention of periprosthetic joint infections

Figures & data

Table 1. Additional clinical considerations

1.	Which bacteria are able to cause HPJI, in what numbers are they required, and can antibiotic prophylaxis influence bacteremia?
2.	Is there an increased risk of HPJI in the first 2 years postoperatively?
3.	Is bleeding during dental treatment an indicator of a higher risk of HPJI?
4.	Are prophylactic antibiotics indicated in patients with an impaired immune status?
5.	What are the risks and benefits of antibiotic prophylaxis for HPJI?
6.	Is antibiotic prophylaxis a cost-effective means of preventing HPJI?
7.	Is dental screening indicated before and/or after prosthesis placement?
8.	Is an antibacterial mouthwash indicated before dental treatment?
9.	What are the international recommendations on antibiotic prophylaxis and dental HPJI?

Table 3. Characteristics of the studies included

Study reference	Study design	Joint type (no. of patients)	Incidence of DHPJI	Conclusion on effect of prophylactic antibiotics on HPJI
Jacobsen and Murray 1980	Retrospective	Hips (n = 1,885)	0.05%	The recommended prophylactic antibiotics should be based on drug sensitivity.
	observational
Ainscow and Denham 1984	Prospective	Hips (n = 885)	No significant influenceof dental treatment on incidence of HPJI	Prophylactic antibiotics would not haveprevented the HPJI cases.
	observational	Knees (n = 115)
Waldman et al. 1997	Retrospective	Knees (n = 3,490)	0.2%	Indicated before extensive dental treatment in patients with systemic disease that com- promises host defense mechanisms against infection.
	observational
LaPorte et al. 1999	Retrospective	Hips (n = 2,973)	0.1%	Indicated before extensive dental treatment in patients with systemic disease that com promises host defense mechanisms against infections.
	observational
Cook et al. 2007	Retrospective	Knees (n = 3,013)	0.03%	n.m.
	observational
Uçkay et al. 2009	Prospective	Hips (n = 4,002)	No significant influence of dental treatment on incidence of HPJI	n.m.
	observational	Knees (n = 2,099)
Berbari et al. 2010	Prospective	Hips (n = 328)	No significant influence of dental treatment on incidence of HPJI	Prophylactic antibiotics do not reduce the risk of DHPJI.
	case-control	Knees (n = 350)
Swan et al. 2011	Retrospective	Knees (n = 1,641)	No significant influence of dental treatment on incidence of HPJI	n.m.
	case-control
Skaar et al. 2011	Retrospective	Hips (n = 468)	No significant influence of dental treatment on incidence of HPJI	Prophylactic antibiotics do not reduce the risk of DHPJI.
	case-control	Knees (n = 501)
		Other (n = 31)

DHPJI: dental treatment-related hematogenous prosthetic joint infection; n.m.: not mentioned.

Flow diagram showing analysis of the literature. ^a There were various reasons for exclusion, which are listed in Table 2.

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