Three Canadian professional organizations have collaborated to create a Consensus Statement on antibiotic prophylaxis for patients who have had total joint replacements.
Hip and knee replacements are some of the most common surgical procedures in Canada, with approximately 1-2.5% of such replacements being complicated by infection. The overwhelming majority of these prosthetic joint infections (PJI) occur in the first year following surgery, and are predominantly due to organisms usually found on the skin. The best available evidence suggests that the majority of PJI are acquired at the time of surgery. Although it is possible that infection can occur due to bacteremia from other sites unrelated to the index surgical procedure—these do occur—the importance of these as a cause of PJI is low.
The Canadian Orthopedic Association (COA), the Canadian Dental Association (CDA) and the Association of Medical Microbiology and Infectious Disease (AMMI) Canada have reviewed the current best available evidence on the effectiveness of dental antibiotic prophylaxis in the reduction of orthopedic prosthetic joint infections, in the context of the issue of emerging antimicrobial resistance and the critical role of all health care providers to steward appropriate use of antimicrobial drugs.
Frequently Asked Questions
Q: What if my patient is immunocompromised? (diabetic, has cancer, rheumatoid arthritis, chronic steroid use etc)
A: Prophylactic antibiotics are indicated in dentistry based on:
- the nature of surgical procedure – and/or
- the patient’s medical status (for example, urgent dental extractions in the face of chemotherapy induced neutropenia; patients with a prosthetic heart valves).
It is NOT the presence or absence of a prosthetic joint that guides this decision
Q: The statement says “Routine antibiotic prophylaxis is not indicated…” Does this mean that these patients should NEVER have antibiotic prophylaxis?
A: As with any sort of guidance document, individual practitioners will consider the best available evidence, patient values and expectations and their own clinical expertise. The statement reflects the best available evidence, but is not prescriptive.
Q: What if the patient’s orthopedic surgeon insists that the patient has antibiotic prophylaxis ?
A: Dentists should
- respect that there will continue to be differences in professional opinion on this matter despite the evidence
- never feel pressured to prescribe antibiotic prophylaxis
- not criticize a decision made by an orthopedic colleague to a patient.
- understand that antibiotic prophylaxis prescription would be the responsibility of the orthopedic surgeon