RESUMEN
We aimed to assess the rate and risk factors of postoperative complications following tooth extraction in HIV-infected patients by CD4 count. The study participants were 231 HIV-infected patients who underwent tooth extraction at our institution between January 2007 and December 2011. Blood test results, underlying diseases, surgical site, extraction method, and postoperative complication data were obtained from medical records. Potential risk factors of postoperative complications were analyzed using multivariate logistic regression. Patients were divided into two groups: 61 (26%) patients with a CD4 count < 200/µL, and 170 (74%) with a CD4 count ≥ 200/µL. Of the 231 patients, 12 (5.2%) developed postoperative complications (alveolar osteitis, n = 10; surgical site infection, n = 2). The rate of complications did not differ between the CD4 < 200/µL group (1.6%) and the CD4 ≥200/µL group (6.5%) (adjusted odds ratio [aOR]: 9.328, 95% confidence interval [CI]: 0.470, 185.229; P = 0.1431). Surgical extraction with bone excavation, but without CD4 count, was identified as a risk factor for post-extraction complications (aOR: 22.037, 95% CI: 1.519, 319.617; P = 0.0234). A low CD4 count is not a risk factor for post-extraction complications in patients with HIV infection. We conclude that tooth extraction should be performed based on dental/oral conditions, and not delayed until CD4 count improvement.
Asunto(s)
Infecciones por VIH/complicaciones , Complicaciones Posoperatorias , Extracción Dental/efectos adversos , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Fármacos Anti-VIH/uso terapéutico , Recuento de Linfocito CD4 , Atención Dental para Enfermos Crónicos , Alveolo Seco/etiología , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Infección de la Herida Quirúrgica/etiologíaRESUMEN
We present a rare case of infectious endocarditis caused by Lactobacillus acidophilus in a patient on long-term steroid use for autoimmune hepatitis. In vitro susceptibility-guided antibiotics with benzylpenicillin plus clindamycin and successive mitral annuloplasty resulted in a favorable outcome. Infectious endocarditis was suspected to be a complication of mistreated periodontal infection. Maintenance of oral hygiene is important in immunocompromised patients.