Dentists Unknowingly Aid Spread of C-diff

Clostridium dificile infections, colloquially referred to as C-diff among hospitalists, are a severe and persistent threat that continues to grow among patients who have been prescribed certain antibiotics. C-diff is one of the most common iatrogenic infections, acquired when a course of antibiotics decimates the patient’s intestinal microbiome. This sudden lack of competition allows C. dificile to rapidly grow and establish within the patient’s colon, causing inflammation and diarrhea that can sometimes be fatal.

At IDWeek, a conference hosted by numerous infectious disease research organizations, findings were presented about the rising number of C-diff infections in Minnesota. The CDC’s Emerging Infections Program carefully tracks C-diff, and interviewed more than 1,500 people who were diagnosed with non-hospital iatrogenic C-diff infections. In particular, epidemiologist Stacy Holzbauer, DVM, MPH, investigated outpatient dental care as a source of iatrogenic C-diff.

The results were troubling. Nearly a thousand of the 1,626 total patients interviewed had been prescribed an antibiotic, and of those, 15 percent had been prescribed an antibiotic by their dentist. As Holzbauer began to analyze the data, some trends emerged. As compared to the patients who were prescribed antibiotics by a physician, patients who received antibiotics at the dentist’s tended to be older (an average of 57 years as opposed to 45), and were prescribed clindamycin far more often. In fact, clindamycin made up half of all antibiotic prescriptions written by dentists.

More troubling still, 34 percent of the dental patients who were prescribed antibiotics did not have that fact notated in their chart. Holzbauer held this up as an example of the critical disconnect between physicians and dentists. “Better communication is needed between patients, dentists, and medical providers,” she said. Many patients do not think to inform their doctors about what medications they are taking for dental problems, nor tell their dentist what medications the doctor has prescribed.

It’s not all the fault of the dentists, however — dentists have notably been overlooked or perhaps even excluded from antibiotic stewardship programs and outreach aiming to educate clinicians on risk mitigation and what constitutes appropriate usage. To curb the rising numbers of C-diff infections, Dr. Holzbauer opines, “It is absolutely critical that [dentists] are included.”

For more information on antibiotic usage guidelines, visit the following links:
ADA Antibiotic Prophylaxis Guidelines
IDSA Practice Guidelines

Sources:
Bye, M., & Bye, M. (2017). Antibiotic Prescribing for Dental Procedures in Community-Associated Clostridium difficile cases, Minnesota, 2009-2015. Idsa.confex.com. Retrieved 13 October 2017, from https://idsa.confex.com/idsa/2017/webprogram/Paper66373.html

Dall, C. (2017). Study links dental antibiotics to C diff cases. CIDRAP. Retrieved 13 October 2017, from http://www.cidrap.umn.edu/news-perspective/2017/10/study-links-dental-antibiotics-c-diff-cases

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