Oral Medicine
Incidence and bacteriology of bacteremia associated with various oral and maxillofacial surgical procedures

https://doi.org/10.1016/j.tripleo.2004.10.022Get rights and content

Objective

The aim of this study was to determine the incidence and bacteriology of bacteremia associated with various oral and maxillofacial surgical procedures.

Methods

A total of 237 patients who underwent oral and maxillofacial surgery were included in this study. Blood samples were obtained for bacteriological examination immediately after the essential steps of the surgical procedure had been performed.

Results

Bacteremia was detected in patients who underwent surgery for tumor, infection and trauma, and surgical reconstruction of jaw. In particular, decortication for osteomyelitis and tooth extraction resulted in a higher incidence of bacteremia compared with other surgical procedures. The incidence of bacteremia was not affected by oral hygiene, gingival inflammation, blood loss, and duration of surgery. Furthermore, concerning tooth extraction, there was no statistical difference in the incidence of bacteremia with respect to the number of teeth extracted and the method of extraction. Extraction of teeth with odontogenic infection (periodontitis, periapical infection, and pericoronitis) did however produce a significantly increased incidence of bacteremia compared with infection-free teeth (P < .01). Viridans streptococci were the predominant group of bacteria isolated from the bacteremias.

Conclusion

Oral and maxillofacial surgery involving transoral incision produces bacteremia, regardless of the extent and degree of surgical invasion. In particular, surgical procedure at infected sites is more likely to result in bacteremia compared with infection-free sites.

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Patients

A total of 237 patients (127 males and 110 females; mean age, 41.0) undergoing oral and maxillofacial surgery at Kanazawa University Hospital between July 2000 and July 2004 were included in the study. Excluded patients included those who had signs of general inflammation (not associated with disease or trauma treated here), immunosuppressed patients, and those receiving antibiotics or medication that might impair the immune system. Written informed consent for this study was obtained from all

Baseline bacteremia

Only 1 of the 46 blood samples (general anesthesia, 1 of 23; local anesthesia, 0 of 23) obtained before the start of surgery was positive for bacteremia, with Peptostreptococcus sp., being isolated.

Incidence of bacteremia associated with oral and maxillofacial surgical procedures

Bacteremia was detected with most of the surgical procedures tested in this study (Table I). Surgery for osteomyelitis resulted in the highest prevalence of positive blood culture (58.3%), closely followed by tooth extraction (57.9%). The incidence of bacteremia in patients who underwent orthognathic

Discussion

In this study, only 1 patient exhibited a positive blood culture obtained before the start of the operation. This low baseline incidence would therefore support the argument of the surgical procedure being the cause of any subsequent bacteremia.

Bacteremia was often detected in patients who underwent surgery for purulent osteomyelitis (Table I). This would support the belief that surgical procedure at infected sites is more likely to produce bacteremia.4

High incidence of post–tooth extraction

References (17)

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    Citation Excerpt :

    This may suggest the etiology behind the higher rates of PJI among RA patients [47]. Many studies demonstrate that there is increased bacteremia after dental procedures [48–54]. Because most PJIs occur within the first 2 years after surgery [55,56], it is recommended that antibiotic prophylaxis be administered during dental procedures to patients at high risk of developing PJI in an effort to reduce the risk of PJI caused by the bacteremia [57].

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