Suppressive antibiotic therapy in prosthetic joint infections: a multicentre cohort study. (April 2020)

• Record Type: Journal Article
• Authors: Escudero-Sanchez, R.; Senneville, E.; Digumber, M.; Soriano, A.; del Toro, M.D.; Bahamonde, A.; del Pozo, J.L.; Guio, L.; Murillo, O.; Rico, A.; García-País, M.J.; Rodríguez-Pardo, D.; Iribarren, J.A.; Fernández, M.; Benito, N.; Fresco, G.; Muriel, A.; Ariza, J.; Cobo, J.
• Is Part Of: Clinical microbiology and infection. Volume 26:Number 4(2020)
• Page Start: 499
• Page End: 505
• Publication Date: 2020-04
• Subjects: Antibiotics -- Postoperative complications -- Prosthesis-related infections -- Prosthetic joint infection -- Suppressive antibiotic treatment; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2019.09.007
• Languages: English
• ISSNs: 1198-743X

Abstract

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.