Abstract
During prosthetic joint infection (PJI), optimal surgical management with exchange of the device is sometimes impossible, especially in the elderly population. Thus, prolonged suppressive antibiotic therapy (PSAT) is the only option to prevent acute sepsis, but little is known about this strategy. We aimed to describe the characteristics, outcome and tolerance of PSAT in elderly patients with PJI. We performed a national cross-sectional cohort study of patients >75 years old and treated with PSAT for PJI. We evaluated the occurrence of events, which were defined as: (i) local or systemic progression of the infection (failure), (ii) death and (iii) discontinuation or switch of PSAT. A total of 136 patients were included, with a median age of 83 years [interquartile range (IQR) 81–88]. The predominant pathogen involved was Staphylococcus (62.1%) (Staphylococcus aureus in 41.7%). A single antimicrobial drug was prescribed in 96 cases (70.6%). There were 46 (33.8%) patients with an event: 25 (18%) with an adverse drug reaction leading to definitive discontinuation or switch of PSAT, 8 (5.9%) with progression of sepsis and 13 died (9.6%). Among patients under follow-up, the survival rate without an event at 2 years was 61% [95% confidence interval (CI): 51;74]. In the multivariate Cox analysis, patients with higher World Health Organization (WHO) score had an increased risk of an event [hazard ratio (HR) = 1.5, p = 0.014], whereas patients treated with beta-lactams are associated with less risk of events occurring (HR = 0.5, p = 0.048). In our cohort, PSAT could be an effective and safe option for PJI in the elderly.
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Acknowledgements
The authors would like to thank the network of actors provided by the French Infectious Diseases Society (SPILF) and the French Society of Geriatrics and Gerontology (SFGG) for their support. They also wish to thank Darren Hart of Publish or Perish, Switzerland, for his invaluable copyediting.
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Conceived and designed the study: AD, EF, GG, VP.
Analysed the data: AD, FH, JS, VP.
Wrote and validated the final version of the paper: all authors.
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Pr. T. Ferry received a travel grant from Novartis in September 2014 (ICAAC, Washington, USA). The other authors declare no conflicts of interest.
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Approval was obtained from the Institutional Review Board of Raymond Poincaré Hospital, Assistance Publique Hôpitaux de Paris (CPP Saint Germain en Laye).
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Because of its retrospective design, no informed consent was needed for this study.
Data availability
The datasets analysed during the current study are available from the corresponding author on reasonable request.
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Prendki, V., Ferry, T., Sergent, P. et al. Prolonged suppressive antibiotic therapy for prosthetic joint infection in the elderly: a national multicentre cohort study. Eur J Clin Microbiol Infect Dis 36, 1577–1585 (2017). https://doi.org/10.1007/s10096-017-2971-2
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DOI: https://doi.org/10.1007/s10096-017-2971-2