Antibiotic prophylaxis for bacteremia in. ..

Antibiotic prophylaxis for bacteremia in patients with joints This information statement has been prepared as a textbook based on the opinions of the authors. Readers are invited to review submitted information and reach their own conclusions. This statement is current AAOS recommendations on this subject. AAOS regularly review and update all information statements, as new technologies, certificate, or policy developed. It is possible that the current recommendations may change as a result of ongoing clinical guidelines development processes around the theme of antibiotic prophylaxis for joint patients dental procedures. Thus, doctors recommended to consider the recommendations in relation to their specific clinical situation and consult, as appropriate, other sources of clinical, scientific and regulatory information for treatment decisions. Doctors urged to check the website AAOS latest information. More than 1000000 shared compatible joint is held annually in the U.S., of which about 7 per cent in revision procedures. Deep infections of total joint usually leads to failure of the commissioning and the need for a broad review of treatment and cost. Through the use of perioperative antibiotic prophylaxis and other technical advances, deep infection occurring in the immediate postoperative period as a result of intraoperative contamination was significantly reduced in the last 20 years. Microbiemia from different sources can lead to hematogenous seeding of bacteria in the joint implants, as in the early postoperative period and for years after implantation. In addition, bacteremia may occur in the normal course of everyday life

while with dental, urological and other surgical and medical procedures. Analogy late prosthetic joint infections infectious endocarditis is invalid as anatomy, blood supply, micro-organisms and mechanisms of infection are different. It is likely that bacteremia associated with acute infection in the mouth, 7.8

skin, respiratory, gastrointestinal and genitourinary systems and / or other sites can and should lead to the end of the infection of implants. Practices should maintain a high index of suspicion for any change or unusual signs and symptoms (eg pain, swelling, fever, joint warm to the touch) in patients with joint prostheses. Any patient with acute prosthetic joint infection should be actively considered for eliminating sources of infection and appropriate antibiotic therapy. 8.9

patients with joints that have invasive procedures or have other infections are at increased risk of hematogenous seeding of the prosthesis. Antibiotic prophylaxis may be considered for those patients who had previous prosthetic joint infection, and those with other conditions that can attract patients to infection (Table 1). 8,10-16

There is evidence that some patients with immunodeficiency common joints may be at higher risk of hematogenous way. However, patients with contacts, plates and screws, orthopedic or other equipment that is not included in the synovial joint is not exposed to risk hematogenous seeding microorganisms. Given the possible adverse outcomes and cost of treatment of infected joint arthroplasty, AAOS recommends that doctors consider antibiotic prophylaxis for joint replacement patients one or more of these risk factors before any invasive procedure that can lead to bacteremia. Table 1. Patients with increased risk of potential hematogenous Total Joint Infection

Inflammatory arthropathy 8,10-16,18 (eg, rheumatoid arthritis, systemic lupus erythematosus)

patients with concomitant diseases (eg diabetes, obesity, HIV infection, smoking)

Preventive antibiotics before any procedure that may lead to bacteremia are selected based on its activity against endogenous flora, which may arise from any other source of secondary bacteremia, its toxicity and its value. In order to prevent bacteremia, appropriate dose of prophylactic antibiotics should be the procedure so that the effective concentration of tissue present in the instrumentation or incision in order to protect patients with joint prostheses bacteremia sepsis induced periproteznyh. Current prophylactic antibiotic recommendations for these different procedures are listed in Table 2. Sometimes patients with joint can provide this doctor with the recommendation of his / her orthopedic surgeon, who does not agree with buy strattera online these recommendations. This may be due to lack of familiarity with guidelines or specific concerns about the health of patients who do not know any doctor or orthopedic surgeon. In this situation, the doctor advised to consult with an orthopedic surgeon to determine whether there are special considerations that may affect the decisions of doctors about whether to pre-medicine, and may wish to share copies of this doctor's recommendations, if necessary. After this consultation, the doctor may decide to follow the recommendations of orthopedic surgeons, or if physicians professional judgment, antibiotic prophylaxis is not indicated, may decide to proceed without antibiotic prophylaxis. Table 2. If the tourniquet is used all the antibiotic dose should be administered to its inflation This statement provides advice in addition to the practices in their clinical judgment regarding antibiotic prophylaxis in patients with joint. It is not intended as a standard treatment or as a substitute for clinical evaluation, since it is impossible to develop guidelines for all possible clinical situations in which bacteremia may occur. Doctor is ultimately responsible for advice on treatment for his / her patients based on professional judgment of clinicians. Any perceived potential benefit of antibiotic prophylaxis must be weighed against the known risk of toxicity of antibiotics, allergy, and the development, selection and transmission of resistant microorganisms. Practitioners must exercise their own clinical judgment in determining whether or not antibiotic prophylaxis appropriate. Literature: The number of patients, the number of procedures, the average age of patients, the average length of stay - the national hospital discharge survey 1998-2005 biennium. Data obtained at: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Rubin R, Salvati EA, Lewis R: Infected total hip arthroplasty after dental procedures. Oral Surg. 1976; 41:13-23. Bender IB, Naidorf IJ, Garvey GJ: Bacterial endocarditis: review for doctors and dentists. Amer J Dent Associate Professor, 1984, 109:415-420. Everett ED, Hirschmann JV: temporary bacteremia and endocarditis prophylaxis: a review. Medicine, 1977, 56:61-77. Guntheroth WG: How important are dental procedures as a cause of infective endocarditis? Amer J Cardiol 1984; 54:797-801. McGowan DA: Dentistry and endocarditis. Br J Dent 1990; 169:69. Bartzokas CA Johnson R, M Jane M. Martin, Pearce PC, Saw Y: The relationship between mouth and hematogenous infection hip joints. BMJ 1994; 309:506-508. Ching DW, Gould IM, Rennie JA, Gibson PH: Prevention of late hematogenous infection in large joint prostheses. J Antimicrob Chemotherapy, 1989, 23:676-680. Pallasch TJ, Slots J: antibiotic and medical risk patient. Periodontics 2000 1996, 10:107-138

Rubin R, Salvati EA, Lewis R: Infected total hip arthroplasty after dental procedures. Oral Surg. 1976; 41:13-23. Brause BD: Infections associated with artificial joints. Clin Rheum Dis 1986; 12:523-536. Jacobson JJ, Millard HD, Plezia R, Blankenship JR: Dental treatment and prosthetic joint infections end. Oral Surg Oral Med Oral Pathol 1986; 61:413-417. Johnson DP, Bannister GG: As a result of infected knee arthroplasty. J Bone Joint Surg; 688:289-291. Jacobson JJ, Patel B Asher G, Wooliscroft JO, Schaberg D: Oral Staphyloccus in elderly patients with arthritis rheumatiod. J Amer Geriatr Soc 1997; 45:1-5. Murray RP, Bourne WH, Fitzgerald RH: Metachronus infection in patients who had more than one total joint arthroplasty. J Bone Joint Surg 1991; 73 - :1469-1474. Posse R, Thornhill TS, Evald FC, Thomas W., Batte NJ, Sledge CB: Factors influencing morbidity and outcome of infection after joint arthroplasty. Clin Orthop 1984; 182:117-126. Board of dental care. Management of dental patients with prosthetic joints. Amer J Dent Assoc 1990; 121:537-538. Berbari EF, Hansen AD, Duffy MC, Ilstrup DM, Harms WS, Osmonov DR: Risk factors for prosthetic joint infection: case-control study. Infectious Clin 1998; 27:1247-1254. Antibiotic prophylaxis in surgery. Medical Letter 2006 4 (52): 83-88 .. Revised June 2010. This material may not be modified without the written permission of the American Academy of orthopedic surgeons. For more information, contact the Public Relations Department at 847-384-4036. .