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Prolonged suppressive antibiotic therapy is successful in the management of prosthetic joint infection

  • Original Article • KNEE - ARTHROPLASTY
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

Prosthetic joint infection (PJI) remains one of the major challenges facing orthopaedic surgeons. There is a paucity of evidence on non-operative management of PJI. We present the results of prolonged antibiotic suppression therapy (PSAT) in PJI from a single centre.

Methods

A retrospective study was performed. Twenty-six patients were included. Two patients were excluded due to the lack of follow-up data. Failure was defined as admission for sepsis from the joint or amputation.

Results

Average age was 72 years (range 35–93). Mean Charlson co-morbidity index was 4.3. Mean follow-up was 3.2 years (range 1.3–5.7). Staphylococcal species were isolated in 11 cases (44%) (MRSA 1, MSSA 5, Staph. epidermidis 4 and Staph Pasteuri 1). Other bacteria included E. Coli (2), Streptococci spp. (3), Propionebacterium acnes (1) and Pseudomonas aeruginosa (1). Four cases were polymicrobial infection (16%), and no organisms were identified in two cases (8%). Candida albicans was identified in one case. All cases of bacterial infection were treated with prolonged oral doxycycline or amoxicillin. Twenty patients (80%) received 6 weeks of intravenous antibiotics prior to commencing prolonged oral antibiotics. Two patients experienced persistent symptoms and required amputation (both TKA). Two patients experienced sepsis but were treated successfully with IV antibiotics alone. The success rate of PSAT was 84% (21/25) successful at an average 3.2-year follow-up.

Discussion and conclusion

Prolonged suppressive antibiotic therapy is a viable option for the management of PJI with a low incidence of complications.

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References

  1. National Joint Registry for England and Wales (NJR) (2018) Report: 15th annual report, 2018. Accessed 24 Dec 2018

  2. Mahmoud SS, Sukeik M, Alazzawi S, Shaath M, Sabri O (2016) Salvage procedures for management of prosthetic joint infection after hip and knee replacements. Open Orthop J 10:600–614. https://doi.org/10.2174/1874325001610010600

    Article  PubMed  PubMed Central  Google Scholar 

  3. Wouthuyzen-bakker M, Nijman JM, Kampinga GA, Van Assen S, Jutte PC (2017) Efficacy of antibiotic suppressive therapy in patients with a prosthetic joint infection. J Bone Jt Infect 2(2):77–83. https://doi.org/10.7150/jbji.17353

    Article  PubMed  PubMed Central  Google Scholar 

  4. Rao N, Crossett LS, Sinha RK, Le frock JL (2003) Long-term suppression of infection in total joint arthroplasty. Clin Orthop Relat Res 414:55–60

    Article  Google Scholar 

  5. Goulet JA, Pellicci PM, Brause BD, Salvati EM (1988) Prolonged suppression of infection in total hip arthroplasty. J Arthroplasty 3(2):109–116

    Article  CAS  PubMed  Google Scholar 

  6. Siqueira MB, Saleh A, Klika AK et al (2015) Chronic suppression of periprosthetic joint infections with oral antibiotics increases infection-free survivorship. J Bone Jt Surg Am 97(15):1220–1232. https://doi.org/10.2106/jbjs.n.00999

    Article  Google Scholar 

  7. Segreti J, Nelson JA, Trenholme GM (1998) Prolonged suppressive antibiotic therapy for infected orthopedic prostheses. Clin Infect Dis 27(4):711–713

    Article  CAS  PubMed  Google Scholar 

  8. Johnson DP, Bannister GC (1986) The outcome of infected arthroplasty of the knee. J Bone Jt Surg Br 68(2):289–291

    Article  CAS  Google Scholar 

  9. Tsukayama DT, Wicklund B, Gustilo RB (1991) Suppressive antibiotic therapy in chronic prosthetic joint infections. Orthopedics 14(8):841–844

    CAS  PubMed  Google Scholar 

  10. Parvizi J, Zmistowski B, Berbari EF et al (2011) New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 469(11):2992–2994. https://doi.org/10.1007/s11999-011-2102-9

    Article  PubMed  PubMed Central  Google Scholar 

  11. Charlson ME, Pompei P, Ales KL, Mackenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  CAS  PubMed  Google Scholar 

  12. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ (2009) The epidemiology of revision total hip arthroplasty in the United States. J Bone Jt Surg Am 91(1):128–133. https://doi.org/10.2106/jbjs.h.00155

    Article  Google Scholar 

  13. Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J (2008) Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 466(7):1710–1715. https://doi.org/10.1007/s11999-008-0209-4

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bengtson S, Borgquist L, Lidgren L (1989) Cost analysis of prophylaxis with antibiotics to prevent infected knee arthroplasty. BMJ 299(6701):719–720

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Grammatopoulos G, Kendrick B, Mcnally M et al (2017) Outcome following debridement, antibiotics, and implant retention in hip periprosthetic joint infection-an 18-year experience. J Arthroplasty 32(7):2248–2255. https://doi.org/10.1016/j.arth.2017.02.066

    Article  PubMed  Google Scholar 

  16. Chew E, Khan WS, Agarwal S, Morgan-jones R (2015) Single stage knee arthroplasty revision surgery: a systematic review of the literature. Open Orthop J 9:504–510. https://doi.org/10.2174/1874325001509010504

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Prendki V, Zeller V, Passeron D et al (2014) Outcome of patients over 80 years of age on prolonged suppressive antibiotic therapy for at least 6 months for prosthetic joint infection. Int J Infect Dis 29:184–189. https://doi.org/10.1016/j.ijid.2014.09.012

    Article  PubMed  Google Scholar 

  18. Prendki V, Sergent P, Barrelet A et al (2017) Efficacy of indefinite chronic oral antimicrobial suppression for prosthetic joint infection in the elderly: a comparative study. Int J Infect Dis 60:57–60. https://doi.org/10.1016/j.ijid.2017.05.008

    Article  CAS  PubMed  Google Scholar 

  19. Masters JP, Smith NA, Foguet P, Reed M, Parsons H, Sprowson AP (2013) A systematic review of the evidence for single stage and two stage revision of infected knee replacement. BMC Musculoskelet Disord 14:222. https://doi.org/10.1186/1471-2474-14-222

    Article  PubMed  PubMed Central  Google Scholar 

  20. Byren I, Bejon P, Atkins BL et al (2009) One hundred and twelve infected arthroplasties treated with ‘DAIR’ (debridement, antibiotics and implant retention): antibiotic duration and outcome. J Antimicrob Chemother 63(6):1264–1271. https://doi.org/10.1093/jac/dkp107

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Prendki V, Ferry T, Sergent P, Oziol E, Forestier E, Fraisse T, Tounes S, Ansart S, Gaillat J, Bayle S, Ruyer O, Borlot F, Le Falher G, Simorre B, Dauchy FA, Greffe S, Bauer T, Bell EN, Martha B, Martinot M, Froidure M, Buisson M, Waldner A, Lemaire X, Bosseray A, Maillet M, Charvet V, Barrelet A, Wyplosz B, Noaillon M, Denes E, Beretti E, Berlioz-Thibal M, Meyssonnier V, Fourniols E, Tliba L, Eden A, Jean M, Arvieux C, Guignery-Kadri K, Ronde-Oustau C, Hansmann Y, Belkacem A, Bouchand F, Gavazzi G, Herrmann F, Stirnemann J, Dinh A (2017) Prolonged suppressive antibiotic therapy for prosthetic joint infection in the elderly: a national multicentre cohort study. Eur J Clin Microbiol Infect Dis 36(9):1577–1585

    Article  CAS  PubMed  Google Scholar 

  22. Nagra NS, Hamilton TW, Ganatra S, Murray DW, Pandit H (2016) One-stage versus two-stage exchange arthroplasty for infected total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 24(10):3106–3114

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. The Complex Arthroplasty Unit, St George’s Hospital, London, UK

    N. A. Sandiford, J. R. Hutt, P. A. Mitchell & L. Granger

  2. Chefarzt Zentrum für Orthopädie und Unfallchirurgie, Berlin, Germany

    D. O. Kendoff

  3. Helios EndoKlinik, Hamburg, Germany

    M. Citak

Authors
  1. N. A. Sandiford
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  2. J. R. Hutt
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  3. D. O. Kendoff
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  4. P. A. Mitchell
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  5. M. Citak
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  6. L. Granger
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Correspondence to N. A. Sandiford.

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Sandiford, N.A., Hutt, J.R., Kendoff, D.O. et al. Prolonged suppressive antibiotic therapy is successful in the management of prosthetic joint infection. Eur J Orthop Surg Traumatol 30, 313–321 (2020). https://doi.org/10.1007/s00590-019-02559-4

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  • DOI: https://doi.org/10.1007/s00590-019-02559-4

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