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Antibiotics Prescribed by Dentists May Be Contributing to CDI Incidence

OCT 06, 2017 | KRISTI ROSA
Minnesota dentists included in a 2015 survey reported prescribing antibiotics for clinical reasons consisting of the following: 84% prescribed prophylaxis for patients suffering from high-risk conditions, 70% prescribed to battle localized swelling, and 38% prescribed antibiotics for patients experiencing gum pain. They also prescribed for nonclinical reasons, due to precautionary (38%) or legal concerns (24%). Furthermore, less than half of the surveyed dentists were concerned about patients experiencing adverse events, antibiotic resistance, or C. difficile.

In their survey, investigators compared the characteristics of those with community-associated CDI (CA-CDI) who took antibiotics for a dental procedure, with CA-CDI cases who took antibiotics for nondental reasons. “The analyses were conducted with chi-square tests using SAS 9.4,” Dr. Bye added.

The investigators identified a total of 2,176 CA-CDI cases between 2009 and 2015; 75% of these cases were confirmed via interview, and more than half, or 57%, of cases reported taking prescribed antibiotics in the 12 weeks prior to diagnosis on interview. Although upper respiratory infections were the most common indication of antibiotics in these CA-CDI cases, dental procedures came in second, with urinary tract infections close behind.

Of the 926 CA-CDI cases who reported taking prescribed antibiotics in the 12 weeks before receiving a diagnosis, 136, or 15%, received antibiotics for a dental procedure. Furthermore, perhaps even more troubling is that 34% of cases reported having been prescribed antibiotics that were not noted in their medical records, suggesting that physicians may not have been aware that they of these prescriptions made by the patients’ dentists.

Some interesting findings yielded from the survey include:
  • Those who received antibiotics for dental procedures were significantly older than those receiving them for other reasons
  • 48% of those who received antibiotics for a dental procedure were prescribed clindamycin, which is commonly associated with CDI and only 30% had it listed in their medical records
  • Collectively—between drugs prescribed and reported in interview and those noted in medical records—50% of cases reported taking clindamycin compared with 10% of those who took nondental antibiotics

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