Acute dental infections managed in an outpatient parenteral antibiotic program setting: prospective analysis and public health implications

William J Connors,Michael D Parkins,Donna L Holton,Heidi H Rabie,Rafael L Figueiredo

doi:10.1186/s12879-017-2303-2

Abstract

BackgroundThe number of Acute Dental Infections (ADI) presenting for emergency department (ED) care are steadily increasing. Outpatient Parenteral Antibiotic Therapy (OPAT) programs are increasingly utilized as an alternative cost-effective approach to the management of serious infectious diseases but their role in the management of severe ADI is not established. This study aims to address this knowledge gap through evaluation of ADI referrals to a regional OPAT program in a large Canadian center.MethodsAll adult ED and OPAT program ADI referrals from four acute care adult hospitals in Calgary, Alberta, were quantified using ICD diagnosis codes in a regional reporting system. Citywide OPAT program referrals were prospectively enrolled over a five-month period from February to June 2014. Participants completed a questionnaire and OPAT medical records were reviewed upon completion of care.ResultsOf 704 adults presenting to acute care facilities with dental infections during the study period 343 (49%) were referred to OPAT for ADI treatment and 110 were included in the study. Participant mean age was 44 years, 55% were women, and a majority of participants had dental insurance (65%), had seen a dentist in the past six months (65%) and reported prior dental infections (77%), 36% reporting the current ADI as a recurrence. Median length of parenteral antibiotic therapy was 3 days, average total course of antibiotics was 15-days, with a cumulative 1326 antibiotic days over the study period. There was no difference in total duration of antibiotics between broad and narrow spectrum regimes. Conservative cost estimate of OPAT care was $120,096, a cost savings of $597,434 (83%) compared with hospitalization.ConclusionsADI represent a common preventable cause of recurrent morbidity. Although OPAT programs may offer short-term cost savings compared with hospitalization, risks associated with extended antibiotic exposures and delayed definitive dental management must also be gauged.

Highlights

The number of Acute Dental Infections (ADI) presenting for emergency department (ED) care are steadily increasing
Of non-traumatic dental visits to EDs in the United States and Canada it is estimated that dental infections represent 40–60% of cases [4, 8]
During the five month-study period 704 individuals presented to regional EDs and urgent care facilities with dental infections of which 343 (49%) severe ADI were referred to the Outpatient Parenteral Antibiotic Therapy (OPAT) program

Summary

Introduction

Despite substantial advances in dental public health over the past century, recent trends in the United States and Canada reveal increasing rates of emergency department (ED) visits and hospitalizations for acute dental infections (ADI) [1,2,3,4]. While retrospective studies in North America and Europe have characterized this epidemic and estimated associated health system resource and financial costs, little is known about the individual and community consequences resulting from acute medical management, for the vast majority of patients with ADI who are not hospitalized. Of non-traumatic dental visits to EDs in the United States and Canada it is estimated that dental infections represent 40–60% of cases [4, 8]. Between 2000 and 2008 ADI hospitalization in the United States increased by 41%, after adjustment for growth, resulting in 8191 admissions in 2008 with attributed healthcare costs exceeding $105 million [2, 11]

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