Long-term antimicrobial suppression prevents treatment failure of streptococcal periprosthetic joint infection. Issue 3 (September 2019)

• Record Type: Journal Article
• Authors: Renz, Nora; Rakow, Anastasia; Müller, Michael; Perka, Carsten; Trampuz, Andrej
• Is Part Of: Journal of infection. Volume 79:Issue 3(2019)
• Page Start: 236
• Page End: 244
• Publication Date: 2019-09
• Subjects: Periprosthetic joint infection -- Streptococcus species -- Outcome -- Biofilms -- Suppression; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2019.06.015
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: Streptococcal periprosthetic joint infections (PJI) are known to have a poor outcome. Of 65 patients with streptococcal PJI, 58% were infection-free at follow up. Antimicrobial suppression improved the treatment success significantly. Suppression was beneficial irrespective of surgical treatment and species. Summary: Objectives: To evaluate the effect of oral antimicrobial suppression on the outcome of streptococcal periprosthetic joint infection (PJI). Methods: Consecutive patients with streptococcal PJI receiving antimicrobial suppression for >6 months were prospectively included and compared to a retrospective control group without suppression. Outcome was assessed with Kaplan-Meier analysis and compared by the log-rank Mantel-Cox test. Multivariate analysis was used to identify factors associated with treatment failure. Results: Of 69 streptococcal PJI episodes (37 knee, 31 hip and one shoulder PJI), 43 (62%) were caused by beta-hemolytic streptococci and 26 (38%) by viridans group streptococci. Debridement and prosthesis retention was performed in 27 (39%), one-stage exchange in 5 (7%), multi-stage exchange in 31 (44%) and prosthesis removal in 6 patients (9%). 24 patients (35%) were treated with antimicrobial suppression receiving oral amoxicillin ( n = 22), doxycycline ( n = 1) or clindamycin ( n = 1). After a median follow-up of 13 months (range, 0.5–111 months), 38 of 65 patients (58%) were infection-free. Suppressive antimicrobial treatment was associated with higher success rate compared with no suppression (93% vs. 57%, p = 0.002), representing the only significant independent factor preventing treatment failure. Conclusions: Long-term antimicrobial suppression was associated with significantly better treatment outcome and should be strongly considered in streptococcal PJI.