RESUMEN
The Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures evidence-based clinical practice guideline was codeveloped by the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association. This guideline replaces the previous AAOS Information Statement, "Antibiotic Prophylaxis in Bacteremia in Patients With Joint Replacement," published in 2009. Based on the best current evidence and a systematic review of published studies, three recommendations have been created to guide clinical practice in the prevention of orthopaedic implant infections in patients undergoing dental procedures. The first recommendation is graded as Limited; this recommendation proposes that the practitioner consider changing the long-standing practice of routinely prescribing prophylactic antibiotic for patients with orthopaedic implants who undergo dental procedures. The second, graded as Inconclusive, addresses the use of oral topical antimicrobials in the prevention of periprosthetic joint infections. The third recommendation, a Consensus statement, addresses the maintenance of good oral hygiene.
Asunto(s)
Implantes Dentales , Procedimientos Quirúrgicos Orales/efectos adversos , Infecciones Relacionadas con Prótesis/prevención & control , Antiinfecciosos/administración & dosificación , Profilaxis Antibiótica , Bacteriemia/epidemiología , Odontología Basada en la Evidencia , Medicina Basada en la Evidencia , Humanos , Incidencia , Indice de Necesidad de Tratamiento Ortodóncico , Higiene BucalAsunto(s)
Prótesis de Cadera/efectos adversos , Prótesis de la Rodilla/efectos adversos , Infecciones Relacionadas con Prótesis/diagnóstico , Antibacterianos/administración & dosificación , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , Humanos , Recuento de Leucocitos , Imagen por Resonancia Magnética , Infecciones Relacionadas con Prótesis/cirugía , Medición de Riesgo , Líquido Sinovial/citología , Tomografía Computarizada por Rayos XRESUMEN
No preferred test for diagnosis of periprosthetic joint infection exists, and the algorithm for the workup of patients suspected of infection remains unclear. The work group evaluated the available literature to determine the role of each diagnostic modality and devise a practical algorithm that allows physicians to reach diagnosis of periprosthetic joint infection. Ten of the 15 recommendations have strong or moderate evidence in support. These include matters involving erythrocyte sedimentation rate and C-reactive protein level testing, knee and hip aspiration, and stopping the use of antibiotics prior to obtaining intra-articular cultures. The group recommends against the use of intraoperative Gram stain but does recommend the use of frozen sections of peri-implant tissues in reoperation patients in whom infection has not been established, as well as multiple cultures in reoperation patients being assessed for infection. The group recommends against initiating antibiotic treatment in patients with suspected infection until after joint cultures have been obtained, but recommends that prophylactic preoperative antibiotics not be withheld in patients at lower probability for infection.
