Oral health, dental prophylaxis and catheter related bloodstream infections in home parenteral nutrition patients: results of a UK survey and cohort study

Abstract

Concern that some catheter related bloodstream infections (CRBSI) arise from dental treatment in home parenteral nutrition (HPN) patients results in recommendation of antibiotic prophylaxis. Clinical guideline 64 is widely recognised and observed. There is a lack of consistent guidance for other patient groups viewed at risk from procedural bacteraemia. 1. An email survey of the British Association for Parenteral and Enteral Nutrition (BAPEN) HPN group, requesting physicians' opinions, observations and practises relating to oral health and CRBSI prevention; 2. Comparison of oral health parameters and dental treatment in relation to patient reported 12 month CVC infection history, using chi-square analysis to assess associations in 52 HPN patients. 1. Sixty-eight percent of the UK HPN Group responded. Fifty percent linked oral health/dental treatment with the possibility of CRBSI, 39% were unsure. Sixty-one percent had recommended parenteral prophylactic antibiotics (82% IV, 18% IM), mainly following the historic infective endocarditis (IE) dental prophylaxis guidelines. Infection with streptococci, prevotella and fusobacteria caused most concern. Amoxicillin, metronidazole, co-amoxyclav and gentamycin were the most prescribed antibiotics. Thirty-six percent might delay HPN if oral health was poor; 57% had recommended dental examination and 25% dental extractions, to prevent or treat CRBSI. 2. Associations between patient recalled CVC infection and their current dental status, the interval since dental treatment or the prophylaxis received over the previous 12 months did not achieve significance. Opinion varies among UK HPN providers on the role of dental treatment and oral health in CRBSI and on prescribing prophylactic antibiotics for dental treatment. Prophylaxis guidance specific to this patient group is required.