PROVIDING CLARITY ON EVIDENCE-BASED PROPHYLACTIC GUIDELINES FOR PROSTHETIC JOINT INFECTIONS BY DANIEL M. MEYER, DDS
The notion of biological plausibility—that is, the likelihood of whether an outcome could occur as a result of a causal association—is frequently a premise for clinical research as well as a basis for clinical decision making. However, what do we as clinicians do when the scientific evidence indicates that a risk factor for a condition, preventive regimen, or treatment is not probable or likely, despite being conceivable? Do we follow precedence, inference, or conflicting professional standards of care, or do we rely on clinical guidelines supported by relevant, scientific evidence from systematic reviews in the peer-reviewed literature? Should we as health care providers discontinue providing conventional care when new scientific evidence from clinical studies indicates a particular therapy or a traditional antibiotic regimen is not necessary, especially if the risk of potential harms outweigh the benefits? Such appears to be the case in regard to the results of systematic reviews in the scientific literature on the use of prophylactic antibiotics to prevent prosthetic joint infections (PJI).
The concept of providing prophylactic antibiotics to prevent PJI has been based on a logical premise and biological plausibility. Dental procedures that involve soft-tissue manipulation or bleeding have the potential to introduce oral bacteria into the blood stream, leading to bacteremia. It has generally been accepted that bacteremia resulting from dental invasive procedures could lead to infection of prosthetic joint implant areas. The common practice, thus far, has been to have patients premedicate with oral antibiotics before dental treatment to prevent bacteremia and postsurgical infections of prosthetic joint implant areas. More recent scientific information published in the peer-reviewed literature is contributing to a greater understanding of the risks versus benefits resulting from the widespread use of antibiotics. Consequently, attitudes regarding the indications and contraindications for antibiotic usage are changing. (click link below to read the rest of the article)