148 - Post-Extraction Infection and Antibiotic Prescribing Among Veterans Receiving Dental Extractions

Background: Dentists prescribe 10% of outpatient antibiotics in the United States, equating to 24.5 million prescriptions annually. However, there is a paucity of data regarding adjunctive antibiotic use in tooth extractions. This study compared post-extraction infections following dental extractions with and without adjunctive antibiotics. Post-extraction infection risk factors and antibiotic prescribing patterns were also investigated.

Methods: This was a retrospective cohort of Veterans with tooth extraction(s) in any Veterans Affairs dental clinic from 1/1/17-12/31/17. A stratified random sample was selected by geographic region, type of extraction (surgical/non-surgical) and post-extraction antibiotic receipt to ensure inclusion of subjects in each of these categories. Subjects who received an antibiotic were compared to those who did not for the occurrence of post-extraction infection as documented in the health record by infectious signs/symptoms or diagnosis. Multivariable regression was performed to identify factors associated with antibiotic receipt.

Results: A sample size of 374 was needed to achieve statistical power based on a 10% risk of infection post-extraction. Nationally, 69,610 patients met inclusion criteria, of which 404 were randomly selected for inclusion. Antibiotics were prescribed to 154 patients (38.1%). There was no difference in post-extraction oral infection among subjects who did and did not receive antibiotics (4.5% vs. 3.2%, p=0.59). Risk factors for post-extraction infection could not be identified due to the low frequency of this outcome. Subjects who received antibiotic prescriptions were more likely to have a greater number of teeth extracted (OR=1.1; 95% CI 1.03-1.2), documentation of acute infection at time of extraction (OR=3.0; 95% CI 1.6-5.8), molar extraction (OR=1.8; 95% CI 1.1-2.9) and extraction performed by an oral maxillofacial surgeon (OR=2.3; 95% CI 1.5-3.6) or specialty dentist (OR=5.8; 95% CI 2.1-16.2).
 
 

Conclusion: Infectious complications were not significantly different among Veterans undergoing tooth extraction who did and did not receive post-extraction antibiotics. Antibiotic prescribing for tooth extraction may be a potential area of focus for outpatient antimicrobial stewardship efforts.