Dentists to Blame for Increasing C Diff Cases?

Dentists who prescribe unnecessary antibiotics are contributing to the spread of community-associated Clostridium difficile, according to research presented at ID Week 2017.

Stacy Holzbauer, DVM, MPH, lead author of the study and career epidemiology field officer for the CDC and the Minnesota Department of Health (MDH) presented their findings. The researchers interviewed 1,626 people with community-associated C difficile between 2009 and 2015, and noted that, of those, 926 reported they had been prescribed antibiotics, and 136 of those for dental procedures.

The study found patients who were prescribed antibiotics for dental procedures tended to be older and more likely to receive clindamycin, an antibiotic that is associated with C diff infection. Of those who had received antibiotics for a dental procedure, 34% had no mention of antibiotics in their medical charts, illustrating the disconnect between dental and medical care.

“Dentists have been overlooked as a source of antibiotic prescribing, which can potentially delay treatment when doctors are trying to determine what is causing a patient’s illness,” Holzbauer said in a press release about the findings. “It’s important to educate dentists about the potential complications of antibiotic prescribing, including C diff. Dentists write more than 24.5 million prescriptions for antibiotics a year. It is essential that they be included in efforts to improve antibiotic prescribing.”

Dentists appropriately prescribe antibiotics in certain situations, such as to treat infections stemming from a tooth abscess. However, some dentists prescribe antibiotics prophylactically before a dental procedure to prevent a heart infection in patients with heart conditions, or to prevent an infection of an artificial joint, such as a hip or knee replacement. The ADA no longer recommends preventive antibiotics in most of those cases, as it once did. Current recommendations note the risk of taking antibiotics—such as developing C diff—is greater than the risk of an infection in those cases.

“Research has shown that reducing outpatient antibiotic prescribing by 10% could decrease C diff rates outside of hospitals by 17%,” Holzbauer explained. “Limiting the use of inappropriate antibiotics in dentistry could also have a profound impact.”

Reference

Bye M, Whitten T, Holzbauer S, et al. Antibiotic Prescribing for Dental Procedures in Community-Associated Clostridium difficile cases, Minnesota, 2009-2015. Presented at: ID Week 2017; San Diego, CA; October 4-8, 2017. Abstract 78.