255. Evaluation of Antibiotic Prescribing at University-Affiliated Dental Clinics
Session: Poster Abstract Session: Antimicrobial Stewardship: Special Populations
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • DentalPoster_9_24_18.pdf (736.6 kB)
  • Background: Dentists prescribe 10% of outpatient antibiotics, yet aside from guidelines for infective endocarditis prophylaxis and against prosthetic joint infection prophylaxis, little is known about appropriate antibiotic use in dentistry. We aimed to describe antibiotic prescribing in dentistry to identify targets for improving prescribing.

    Methods: We performed a cross-sectional study of patients receiving antibiotics between 10/1/2014 and 9/30/2016 at 1 of 3 University of Utah (UU) Dentistry clinics. Antibiotic prescriptions entered through the dental practice management software (Dentrix) were pulled from the UU data warehouse and linked with medical records. We assessed antibiotic prescribing rates, most commonly prescribed agents, frequency of documented beta-lactam allergies, and duration of therapy. Prescriptions were categorized as for prophylaxis based on administration directions or antibiotics administered as one-time doses in the clinic. Finally, we measured the frequency of cardiac indications for pre-procedure antibiotic prophylaxis and indicators that may be drivers of unnecessary antibiotic use (e.g., prosthetic joint).

    Results: 1718 antibiotic prescriptions occurred in the study period, with a prescribing rate of 48/1000 dental visits. Penicillins were the most commonly prescribed class [81% (1399/1718)]. 6% (96/1718) of prescriptions were consistent with infection prophylaxis. 30% (29/96) of those receiving prophylaxis had a cardiac indication for dental prophylaxis, and 23% (22/96) had prosthetic joints. Mean non-prophylactic antibiotic duration was 8 days (standard deviation 3.9 days). 10% (180/1718) of prescriptions were in patients with a documented beta-lactam allergy. The majority of these patients [62% (111/180)] received clindamycin.

    Conclusion: The majority of prescriptions evaluated were not consistent with pre-procedure prophylaxis. Prophylaxis was frequently prescribed in patients without prophylactic indications. While improving prophylactic use of antibiotics for dental procedures is an important antibiotic stewardship target, a better understanding of the use of treatment courses could have more significant implications for dental antibiotic stewardship efforts.

    Emily Spivak, MD, MHS1, James Winkler, DDS, PhD2, Barbara Dixon, RDH, BS, MEd2, Lilliam Pinzon, DDS, MS, MPH2, Dania Al Dulaimi, BS2, McKenna Nevers, MSPH3, Michele Junger, DDS, MPH4, Katherine Fleming-Dutra, MD5, Karl Madaras-Kelly, PharmD., MPH6 and Matthew Samore, MD, FSHEA7, (1)Internal Medicine, University of Utah Health, Salt Lake City, UT, (2)University of Utah School of Dentistry, Salt Lake City, UT, (3)IDEAS Center, Salt Lake City VA Health Care System, Salt Lake City, UT, (4)Division of Oral Health, Centers for Disese Control and Prevention, Atlanta, GA, (5)CDC, Atlanta, GA, (6)Vet. Med. Ctr., Boise, ID, (7)University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT

    Disclosures:

    E. Spivak, None

    J. Winkler, None

    B. Dixon, None

    L. Pinzon, None

    D. Al Dulaimi, None

    M. Nevers, None

    M. Junger, None

    K. Fleming-Dutra, None

    K. Madaras-Kelly, None

    M. Samore, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.