Suppressive antibiotic therapy in prosthetic joint infections: a multicentre cohort study.

Abstract

OBJECTIVES:

The aim was to describe the effectiveness of suppressive antibiotic treatment (SAT) in routine clinical practice when used in situations in which removal of a prosthetic implant is considered essential for the eradication of an infection, and it cannot be performed.

METHODS:

This was a descriptive retrospective and multicentre cohort study of prosthetic joint infection (PJI) cases managed with SAT. SAT was considered to have failed if a fistula appeared or persisted, if debridement was necessary, if the prosthesis was removed due to persistence of the infection or if uncontrolled symptoms were present.

RESULTS:

In total, 302 patients were analysed. Two hundred and three of these patients (67.2%) received monotherapy. The most commonly used drugs were tetracyclines (39.7% of patients) (120/302) and cotrimoxazole (35.4% of patients) (107/302). SAT was considered successful in 58.6% (177/302) of the patients (median time administered, 36.5 months; IQR 20.75-59.25). Infection was controlled in 50% of patients at 5 years according to Kaplan-Meier analysis. Resistance development was documented in 15 of 65 (23.1%) of the microbiologically documented cases. SAT failure was associated with age <70 years (sub-hazard ratio (SHR) 1.61, 95% CI 1.1-2.33), aetiology other than Gram-positive cocci (SHR 1.56, 95% CI 1.09-2.27) and location of the prosthesis in the upper limb (SHR 2.4, 95% CI 1.5-3.84). SAT suspension was necessary due to adverse effects in 17 of 302 patients (5.6%).

CONCLUSIONS:

SAT offers acceptable results for patients with PJI when surgical treatment is not performed or when it fails to eradicate the infection.

• Authors: R Escudero-Sanchez, E Senneville, M Digumber, A Soriano, M D Del Toro, A Bahamonde, J L Del Pozo, L Guio, O Murillo, A Rico, M J García-País, D Rodríguez-Pardo, J A Iribarren, M Fernández, N Benito, G Fresco, A Muriel, J Ariza, J Cobo
• Journal: Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases (Clin Microbiol Infect) Vol. 26 Issue 4 Pg. 499-505 (Apr 2020) ISSN: 1469-0691 [Electronic] England
• PMID: 31539638 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Anti-Bacterial Agents

Topics

• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (therapeutic use)
• Arthritis, Infectious (drug therapy, microbiology)
• Bacteria (drug effects)
• Debridement
• Female
• Humans
• Male
• Middle Aged
• Prosthesis-Related Infections (drug therapy, microbiology)
• Retrospective Studies
• Treatment Outcome