Since bacteremia is a surrogate outcome measure for remote or distant infection and follows also daily hygiene practices, it may be unnecessary to prevent bacteremia in most patients and in most dental procedures.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias «Additional comments for included studies...»2 |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis | |||||
| «Lafaurie GI, Noriega LA, Torres CC, et al. Impact ...»1 | SR/MA | Medline Embase search RCT/CCTs (12) adult or children patients (n= 1 544) |
Antimicrobial (amoxicillin 10, cephalosporin 2, clindamycin 3, azithromycin 1, moxifloxacin 1, amox-clavul 1 study) prophylaxis administered p.o. before dental procedure compared to placebo or no treatment | Incidence, magnitude and duration of bacteremia 30s, 30 min and 60 min after procedure and isolated micro-organisms | moderate |
| «Zeng BS, Lin SY, Tu YK, et al. Prevention of Postd...»2 | Network MA | ClinicalKey, Cochrane CENTRAL, Embase, ProQuest, PubMed, ScienceDirect, Web of Science,
and ClinicalTrials.gov RCTs (24) 2 147 participants |
Prophylactic interventions for the prevention of postdental (tooth extaction) procedure bacteremia e.g, 2 g amoxicillin p.o, | Incidence of postdental procedure bacteremia | |
| «Cahill TJ, Harrison JL, Jewell P, et al. Antibioti...»3 | SR/MA | Medline, (OvidSP) Embase (OvidSP) Cochrane Central Register of Controlled Trials,
Cochrane Database of Systematic Reviews Science Citation Index Expanded & Conference
Proceedings Citation Index, Clinicaltrials.gov and the WHO International, Clinical
Trials Registry Platform 36 studies |
Antimicrobial prophylaxis for dental procedures compared to no prophylaxis and time-trend chances regarding to guidelines | incidence of infective endocarditis and bacteremia | high |
| «Mougeot FK, Saunders SE, Brennan MT, et al. Associ...»4 | RCT | Patients with single tooth extractions n = 290 | single extraction with AP (2 g amoxicillin 1 h preop compared to single extraction
with placebo or toothbrushing group |
incidence of bacteremia incidence of bacteremia with bacteria associated with PJI or IE |
|
| Reference | Comments |
|---|---|
| «Lafaurie GI, Noriega LA, Torres CC, et al. Impact ...»1 | 3 studies had low risk of bias, and 9 trials had unclear or high risk of bias. Lack
of participant and personnel blinding and incomplete outcome data were the most common
factors for risk of bias. Heterogenity was significant I2 = 93 %, for subgroups 88 % All studied procedures were single or multiple dental extractions |
| «Zeng BS, Lin SY, Tu YK, et al. Prevention of Postd...»2 | Results for dental extractions presented. Only 3 (of 24) studies addressed minor adverse events, and none of the included studies reported serious adverse events, such as anaphylactic shock, mortality, and development of antibiotic-resistant bacteria |
| «Cahill TJ, Harrison JL, Jewell P, et al. Antibioti...»3 | All studies were assessed to be at high risk of intrinsic methodological bias. Heterogenity was significant i2 = 90 % (bacteremia studies) |
| «Mougeot FK, Saunders SE, Brennan MT, et al. Associ...»4 | Study participants presented hospital-based urgent care dental clinic attenders in need of an extraction and therefore may not represent the general population with regard to demographic characteristics and severity of dental disease |
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95 % CI) |
|---|---|---|---|---|---|
| Level of evidence: moderate The quality of evidence is downgraded due to risk of bias in included studies (blinding, incomplete outcome data, imprecision) and significant heterogenity among studies. I= intervention; C=comparison; CI=confidence interval |
|||||
| «Lafaurie GI, Noriega LA, Torres CC, et al. Impact ...»1 | total 12 studies 774/770 amoxicillin 10 412/410 clindamycin 3 146/148 cephalosporin 2 49/49 azithromycin 1 57/55 |
directly after up to 60 min | 318 135 99 23 28 |
600 285 118 40 53 |
0.50 (0.38 to 0.67) 0.41 (0.41 to 0.62) 0.89 (0.81 to 0.97) 0.55 (0.11 to 2.68) 0.51 (0.39 to 0.67) |
| «Zeng BS, Lin SY, Tu YK, et al. Prevention of Postd...»2 | amoxicillin | from 2 min to 7 d after procedure, median 15 min | 0.18 (0.06-0.52) | ||
| «Cahill TJ, Harrison JL, Jewell P, et al. Antibioti...»3 | total 35 studies 1 353/1 408 |
499 | 973 | 0.53 (0.49 to 0.57) | |
| «Mougeot FK, Saunders SE, Brennan MT, et al. Associ...»4 | tooth brushing 98 extr AP 96 extr without AP 96 |
6 time points before, during and after | Incidence of bacteremia 32 % IE assoc 23 % PJI assoc 12 % 56 % IE assoc 33 % PJI assoc 14 % 80 % IE assoc 60 % PJI assoc 52 % |
||
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95 % CI) |
|---|---|---|---|---|---|
| Level of evidence: very low The quality of evidence is downgraded due to (study limitations, small sample sizes). I= intervention; C=comparison; CI=confidence interval |
|||||
| «Lafaurie GI, Noriega LA, Torres CC, et al. Impact ...»1 | 2 studies | 1.among amoxicillin (0.3 [0.73] colony-forming units [CFU] per milliliter), chlorhexidine
(2.3 [4.11] CFU/mL), and the control (1.9 [5.32] CFU/mL) (P > .05). 2. all analyzed samples had bacteremia levels below the detection (PCR) threshold of 104 CFU/mL of blood |
|||
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95 % CI) |
|---|---|---|---|---|---|
| Level of evidence: low The quality of evidence is downgraded due to (study limitations, small sample sizes). I= intervention; C=comparison; CI=confidence interval |
|||||
| «Lafaurie GI, Noriega LA, Torres CC, et al. Impact ...»1 | amoxicillin amoxicillin |
30 min 60 min |
0 % 3,7–4 % |
11 % 20–18 % |
|
Comments:
The antibiotics indicated for the prevention of IE-associated bacteremia in patients with penicillin allergy, clindamycin and cephalosporin appear to be less effective «Lafaurie GI, Noriega LA, Torres CC, et al. Impact ...»1 than azithromycin for controlling bacteremia involving viridans streptococci and anaerobic microorganisms. Resistance to antibiotics may affect the results obtained from different areas. Azithromycin was evaluated only in one study.
In RCTs and nRCTs «Martins CC, Lockhart PB, Firmino RT, et al. Bacter...»5, peak in bacteremia incidence was reported within 5min after the end of the procedure. Bacteremia incidence then decreased slowly for up to 2h. Dental extractions showed the highest incidence of bacteremia (62 %–66 %), followed by scaling and root planing (SRP) (44 % – 36 %) and oral health procedures (OHP) (e.g., dental prophylaxis and dental probing without SRP) (27 % – 28 %). Other ADL (flossing and chewing) (16 %) and toothbrushing (8 % – 26%) resulted in bacteremia as well.
The magnitude of bacteremia has been studied only in few studies «Lafaurie GI, Noriega LA, Torres CC, et al. Impact ...»1, «Reis LC, Rôças IN, Siqueira JF Jr, et al. Bacterem...»6 and it has been argued whether the magnitude of bacteremia after dental procedures reaches the level needed to cause remote infections like infective endocarditis. Comorbidities may increase the risk for infection complications due to bacteremia.