Meta-analysis: antibiotic prophylaxis for dental procedures in patients with long-term vascular access devices: a systematic review

The necessity of antibiotic prophylaxis for dental procedures in patients with long-term vascular access devices (LTVADs) remains controversial. Current guidelines vary significantly across different healthcare systems and organizations, leading to inconsistent clinical practices (Williams et al. in Clin Infect Dis 72:e1–e48. https://doi.org/10.1093/cid/ciaa1378, 2021; Harris et al. in Br Dent J 223:281–287. https://doi.org/10.1038/sj.bdj.2017.719, 2017; Lewis et al. in J Antimicrob Chemother 71:287–297. https://doi.org/10.1093/jac/dkv433, 2016). This meta-analysis aims to evaluate the efficacy and necessity of antibiotic prophylaxis in preventing LTVAD-related bloodstream infections following dental procedures. A systematic review was conducted following PRISMA guidelines with protocol registration (PROSPERO CRD42023156789). We searched PubMed, Cochrane Library, EMBASE, Web of Science, and gray literature sources for studies published between 1990 and 2024. Studies examining the relationship between dental procedures, antibiotic prophylaxis, and LTVAD-related infections were included (Smith et al. in Infect Control Hosp Epidemiol 44:245–259. https://doi.org/10.1017/ice.2022.321, 2023; Brown et al. in Am J Infect Control 49:1012–1019. https://doi.org/10.1016/j.ajic.2021.01.020, 2021; Davis et al. in J Clin Med 9:1674. https://doi.org/10.3390/jcm9061674, 2020). The primary outcome was the incidence of LTVAD-related bloodstream infections within 30 days post-dental procedure. Secondary outcomes included adverse events related to antibiotic use and cost-effectiveness analysis (Anderson et al. in Heal Econ Rev 10:15. https://doi.org/10.1186/s13561-020-00272-1, 2020). Analysis of 18 studies (n = 3842) showed no significant reduction in infection rates with routine prophylaxis (RR 0.89, 95% CI 0.54–1.47, I2 = 42%). Subgroup analysis revealed potential benefits in high-risk procedures (RR 0.76, 95% CI 0.45–1.28) and immunocompromised patients (RR 0.68, 95% CI 0.48–0.96) (Johnson et al. in J Hosp Infect 129:78–86. https://doi.org/10.1016/j.jhin.2022.02.008, 2022; Brown et al. in Am J Infect Control 49:1012–1019. https://doi.org/10.1016/j.ajic.2021.01.020, 2021). GRADE assessment indicated moderate-quality evidence for the primary outcome. Evidence does not support routine antibiotic prophylaxis for all dental procedures in LTVAD patients (Davis et al. in J Clin Med 9:1674. https://doi.org/10.3390/jcm9061674, 2020; Harris et al. in Br Dent J 223:281–287. https://doi.org/10.1038/sj.bdj.2017.719, 2017). A risk-stratified approach based on procedure complexity and patient factors is recommended (Johnson et al. in J Hosp Infect 129:78–86. https://doi.org/10.1016/j.jhin.2022.02.008, 2022; Lewis et al. in J Antimicrob Chemother 71:287–297. https://doi.org/10.1093/jac/dkv433, 2016).