Infectious complications of dental procedures in dogs and cats, and the impact of antimicrobial prophylaxis: a systematic review

OBJECTIVES: To identify and describe available evidence pertaining to the local and systemic infectious complications in dogs and cats that have undergone dental procedures and the impact of peri-procedural antimicrobial prophylaxis. MATERIALS AND METHODS: A systematic review was performed based on Preferred Reporting Items for Systematic Reviews and MetaAnalysis guidelines. RESULTS: No studies clearly reported the incidence of sepsis or infective endocarditis data associated with dental procedures. The pooled prevalence of post-dental procedure bacteraemia was 47% (95% confidence interval 23% to 74%). Two studies investigated both dogs undergoing dental procedures and controls. Neither showed a clear association of dental procedures and bacteraemia. Bacteraemia was not associated with any clinical consequences based on these data, but data were very limited, with a very low level of certainty of evidence. No studies evaluated the impact of peri-procedural antimicrobial on endocarditis, sepsis or other infectious complications. Two relevant studies that used bacteraemia as the outcome were identified. Both studies were deemed to have some concerns of bias. Certainty of evidence was deemed to be very low. No data were available to assess the impact of post-procedural antimicrobials on infectious complications. CLINICAL SIGNIFICANCE: The evidence base to assess the incidence and risks of infectious complications after dental procedures and impact of antimicrobial prophylaxis in dogs and cats is severely limited. This highlights a major research gap for a common patient population and hampers development of evidence-based guidelines for peri-procedural antimicrobial administration in dogs and cats.