Surgical Site Infections in Dental Procedures: A Patient's Journey

Q: Surgical Site Infections in Dental Procedures: A Patient's Journey

Hello： I apologize, but your question is not within my area of expertise. <br>I recommend consulting the oral surgery department at a major hospital.

Intraoperative surgical site infection?

I was in a car accident in 2005, resulting in a comminuted fracture of the distal femur.
I underwent six surgeries and was hospitalized for over five months, ultimately developing chronic osteomyelitis.
Later, I sought treatment from renowned physicians in the north and found Dr.
Weng Wen-Neng at Chang Gung Memorial Hospital in Linkou.
After undergoing seven surgeries, I was discharged in 2006 following a bone graft.
I adhered to medical advice, supplementing my diet daily with high-protein plant-based foods (soy milk, milk, and soy products), seaweed, multivitamins, dried small fish, and sun exposure, along with massages to stimulate peripheral nerves.
In 2009, I experienced trigeminal neuralgia (pain in the second and third branches) and visited a dentist.
I informed the dentist about my history of chronic osteomyelitis (with 13 surgeries in total), and I was hospitalized for intravenous Vancomycin treatment, receiving four bottles a day.
I was concerned that tooth extraction, being an invasive procedure, might trigger chronic osteomyelitis, but the dentist assured me it would not and prescribed antibiotics.
However, a few days post-surgery, the extraction site became red, swollen, hot, and painful.
I was hospitalized again, and blood tests showed elevated inflammatory markers: WBC 13.5, ESR 62, CRP 260.37, with cultures revealing Coagulase-negative Staphylococcus.
I remained hospitalized for over a month and underwent debridement surgery.
Subsequently, other dental professionals and pharmacists from different medical centers advised that using Augmentin would be safer, as it enhances the efficacy of Amoxicillin and provides better resistance against methicillin-resistant Staphylococcus aureus (MRSA) infections.
Additionally, my attending physician confirmed that the bacteria could have entered the bloodstream, leading to systemic bacteremia, and classified it as a pathogenic organism.
I would like to hear the dentist's perspective on this matter.

Xiao Ding Dang, 40~49 year old female. Ask Date: 2013/11/12

Dr. Zhuang Suhui reply Dentistry

Hello: I apologize, but your question is not within my area of expertise.
I recommend consulting the oral surgery department at a major hospital.

Reply Date: 2013/11/12

More Info

Surgical site infections (SSIs) are a significant concern in any surgical procedure, including dental surgeries. Your experience highlights the complexities and potential risks associated with surgical interventions, especially for patients with a history of chronic infections, such as chronic osteomyelitis.
Chronic osteomyelitis is a persistent bone infection that can arise from various causes, including trauma, surgery, or hematogenous spread from other infections. In your case, the history of multiple surgeries and the development of chronic osteomyelitis following a severe injury underscore the importance of careful management and monitoring during any subsequent surgical procedures, including dental extractions.

When it comes to dental procedures, such as tooth extractions, the risk of infection can be influenced by several factors, including the patient's medical history, the complexity of the procedure, and the post-operative care. In your situation, the concern about whether a dental extraction could trigger a recurrence of chronic osteomyelitis is valid, especially given your previous medical history. However, it is essential to note that while dental procedures are invasive, they are typically low-risk for causing systemic infections like osteomyelitis, particularly when appropriate prophylactic measures are taken.

Antibiotic prophylaxis is a common practice in dentistry, especially for patients with a history of infections. In your case, the dentist prescribed Amoxicillin, which is effective against many common oral bacteria. However, as you experienced complications, it is crucial to understand that not all antibiotics are equally effective against all pathogens. For instance, Coagulase-negative Staphylococcus (Coag(-) Staphylococcus) and Methicillin-resistant Staphylococcus aureus (MRSA) are known to be more resistant to standard antibiotics like Amoxicillin. This is where Augmentin, which combines Amoxicillin with clavulanate, can provide broader coverage against resistant strains.

Your post-operative symptoms, including redness, swelling, and elevated inflammatory markers, indicate a potential infection. The fact that you were hospitalized and required further intervention, such as debridement, suggests that the initial antibiotic treatment may not have been sufficient to control the infection. This situation emphasizes the importance of close monitoring and follow-up after dental procedures, especially for patients with complex medical histories.

In terms of prevention, several strategies can be employed to reduce the risk of SSIs in dental procedures:
1. Preoperative Assessment: A thorough evaluation of the patient's medical history, including any previous infections, is crucial. This assessment helps in determining the need for antibiotic prophylaxis.

2. Antibiotic Prophylaxis: Administering appropriate antibiotics before the procedure can help prevent infections, particularly in patients at higher risk.

3. Sterile Technique: Ensuring that all instruments and materials used during the procedure are sterile is vital in preventing contamination.

4. Postoperative Care: Patients should be educated on signs of infection, such as increased pain, swelling, or fever, and advised to seek prompt medical attention if these occur.

5. Follow-Up: Regular follow-up appointments can help monitor the healing process and catch any potential complications early.

In conclusion, your experience illustrates the intricate relationship between surgical procedures and infection risks, particularly in patients with a history of chronic infections. It is essential to maintain open communication with healthcare providers, adhere to prescribed treatments, and report any concerning symptoms promptly. By taking these precautions, the risks associated with surgical site infections can be significantly minimized, leading to better outcomes for patients undergoing dental procedures.

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