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Antibiotics Prescribed by Dentists May Be Contributing to CDI Incidence

OCT 06, 2017 | KRISTI ROSA
Out of all of the healthcare-associated infections that plague health officials, healthcare facilities, and patients alike, Clostridium difficile (C. difficile) is the most common, accounting for upwards of 453,000 cases and a staggering excess financial burden of $1 million on an annual basis.

The threat of C. difficile has investigators all over the world on a mission to learn more about the troublesome infection in order to get a better handle on prevention and control efforts. At ID Week 2017, held in San Diego, California, Maria Bye, MPH, an epidemiologist at the Minnesota Department of Health, provided troublesome insight gleaned from an active population- and laboratory-based Clostridium difficile infection (CDI) surveillance survey: dentists are contributing to the incidence of CDI.

In her presentation, Dr. Bye stressed that antibiotic exposure is a major risk factor for CDI, and unfortunately, dentists have been relatively left out of the conversation when it comes to the development of antibiotic stewardship programs. They shouldn’t be, she argued, as recent data has found that dentists prescribed about 10% of antibiotics in the outpatient setting in the United States in 2013 alone—that amounts to upwards of 24 million prescriptions!

“In dentistry, antibiotics are indicated to treat oral infections, such as tooth abscesses,” Dr. Bye explained. “Historically, recommendations for antibiotic prophylaxis have been created for 2 specific groups of patients: those with heart conditions that may predispose them to infective endocarditis and those with prosthetic joints who may be at risk for developing an infection at the site of the prosthetic.”

However, guidelines for prophylaxis before invasive dental procedures for patients with congenital heart disease and prophylaxis guidelines for patients with prosthetic joints have evolved over the years. The American Dental Association recommends prophylaxis only for patients with specific heart conditions, rather than all congenital heart conditions, and prophylaxis is no longer recommended for patients with prosthetic joints. However, some clinicians continue to prescribe prophylaxis regardless of the recommendations.

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