Dental Antibiotics Linked to C. Diff Infection Problems: Study

New research indicates the cause of many community-acquired cases of Clostridium difficile (C. diff) infections stem from antibiotics given to prevent dental infections. 

In a study presented during ID Week 2017, a conference held jointly by the Infectious Diseases Society of America, the Pediatric Infectious Disease Society, the Society for Healthcare Epidemiology of America, and the HIV Medicine Association, researchers warn that there is a disconnect between medical and dental care that could be contributing to the spread of C. diff infections.

In recent years, C. diff rates have doubled in the United States. Researchers attribute the increase to antibiotic overuse, as more than a half a million people are infected by C. diff.

The Minnesota Department of Health (MDH) tracked community-associated C. diff infections from five counties in the state over the course of six years among patients who did not have overnight stays in the hospital or a nursing home.

Researchers from the MDH interviewed 1,626 people with community-associated C. diff between 2009 and 2015. Nearly, 60% reported they were prescribed antibiotics by doctors. Of those, 15% said they were prescribed antibiotics for dental procedures. Patients who received antibiotics were generally older and more likely to receive clindamycin, an antibiotic associated with C. diff infections.

Nearly one-third of those patients’ medical charts did not indicate they received dental antibiotics.

Researchers said there is a clear disconnect between dental and medical care. Patients should discuss dental visits, especially antibiotics, and doctors should ask patients about any antibiotics patients may have been given from any physician.

A different MDH study concluded 36% of dentists prescribe antibiotics in situations that are generally not recommended by the American Dental Association (ADA). Dentists often prescribe antibiotics as a prophylactic to prevent infections before they occur, instead of treating already existing infections, such as those from abscesses.

However, the ADA does not recommend preventive antibiotics, but many dentists are not aware of the updated recommendations.

Stacy Holzbauer, lead author of the study and career epidemiology field officer for the U.S. Centers for Disease Control and Prevention (CDC) and MDH said that dentists’ antibiotic prescriptions have been overlooked, and with them giving out more than 24.5 million antibiotic prescriptions per year, it was essential that they be included in efforts improving antibiotic prescribing.

Clostridium difficile is a potentially deadly infection, which often causes severe diarrhea. Antibiotics work against infections by killing bad bacteria, however, they also kill off any good bacteria. Killing beneficial bacteria that keeps C. diff in check can allow it to spread.

C. diff infections are one of the top three most urgent antibiotic resistant threats, according to the CDC. Able to spread after only one dose of antibiotics, it causes more than half a million infections and leads to more than 15,000 deaths each year.

Study authors cite other research which shows reducing outpatient antibiotic prescribing by 10% could decrease C. diff infection rates outside of hospitals by 17%.  As antibiotic use often results in C. diff infections in hospital settings, reducing antibiotic use can also help to reduce the creation and emergence of antibiotic resistant bacteria, or superbugs.