Do you recommend antibiotic prophylaxis for an ESKD patient with a tunneled dialysis catheter who is planned for a dental procedure?

I do not. Which procedures require antibiotic prophylaxis has always been a very confusing issue for me. It also seems to change often. However, with dental procedures, the main organism responsible for bacteremia is streptococcus of viridans group which is an unlikely cause of line infection. I think the risk is low enough not to warrant antibiotic prophylaxis. Breakdown in sterile precautions or suboptimal catheter care by patients is likely a much more likely cause of catheter infections.

Dental procedures are associated with both transient bacteremia and endocarditis, likely from the tissue trauma that opens up small blood vessels to bacterial entry. The oral cavity, with its multitude of microorganisms, is a particularly good source for bacteremia when invasive procedures are performed. Moreover, brushing teeth is also associated with bacteremia. It is estimated that brushing can cause > 200 episodes of bacteremia per year compared to episodes of bacteremia from an average of fewer than 2 dental visits per year (Lockhart et al., PMID 18541739).

HD patients are prone to 2 types of infection with transient bacteremia: endocarditis and vascular access infection. Prophylactic antibiotics prior to dental procedures are used pri...