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European Journal of Clinical Microbiology & Infectious Diseases

15-05-2024 | Antibiotic | Original Article

Impact of antibiotic prophylaxis in second-stage surgery in joint prosthesis infection treated with two-stage exchange. A multicenter case–control study

Authors: Jose M. Barbero Allende, Encarnación Fernández Antón, Joan Gómez-Junyent, Lluisa Sorlí Redó, Dolors Rodríguez-Pardo, Óscar Murillo Rubio, Marta Fernández Sampedro, Rosa Escudero-Sánchez, Manuel García Gutiérrez, Ma Eugenia Portillo, Ignacio Sancho, Alicia Rico Nieto, Laura Guio Carrión, Alex Soriano Viladomiu, Laura Morata Ruiz, Francisco José de Abajo Iglesias

Published in: European Journal of Clinical Microbiology & Infectious Diseases

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Abstract

Introduction

After two-stage exchange due to prosthetic joint infection (PJI), the new prosthesis carries a high risk of reinfection (RePJI). There isn`t solid evidence regarding the antibiotic prophylaxis in 2nd-stage surgery. The objective of this study is to describe what antibiotic prophylaxis is used in this surgery and evaluate its impact on the risk of developing RePJI.

Methods

Retrospective multicenter case–control study in Spanish hospitals. The study included cases of PJI treated with two-stage exchange and subsequently developed a new infection. For each case, two controls were included, matched by prosthesis location, center, and year of surgery. The prophylaxis regimens were grouped based on their antibacterial spectrum, and we calculated the association between the type of regimen and the development of RePJI using conditional logistic regression, adjusted for possible confounding factors.

Results

We included 90 cases from 12 centers, which were compared with 172 controls. The most frequent causative microorganism was Staphylococcus epidermidis with 34 cases (37.8%). Staphylococci were responsible for 50 cases (55.6%), 32 of them (64%) methicillin-resistant. Gram-negative bacilli were involved in 30 cases (33.3%), the most common Pseudomonas aeruginosa. In total, 83 different antibiotic prophylaxis regimens were used in 2nd-stage surgery, the most frequent a single preoperative dose of cefazolin (48 occasions; 18.3%); however, it was most common a combination of a glycopeptide and a beta-lactam with activity against Pseudomonas spp (99 cases, 25.2%). In the adjusted analysis, regimens that included antibiotics with activity against methicillin-resistant staphylococci AND Pseudomonas spp were associated with a significantly lower risk of RePJI (adjusted OR = 0.24; 95% IC: 0.09–0.65).

Conclusions

The lack of standardization in 2nd-satge surgery prophylaxis explains the wide diversity of regimens used in this procedure. The results suggest that antibiotic prophylaxis in this surgery should include an antibiotic with activity against methicillin-resistant staphylococci and Pseudomonas.
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Metadata
Title
Impact of antibiotic prophylaxis in second-stage surgery in joint prosthesis infection treated with two-stage exchange. A multicenter case–control study
Authors
Jose M. Barbero Allende
Encarnación Fernández Antón
Joan Gómez-Junyent
Lluisa Sorlí Redó
Dolors Rodríguez-Pardo
Óscar Murillo Rubio
Marta Fernández Sampedro
Rosa Escudero-Sánchez
Manuel García Gutiérrez
Ma Eugenia Portillo
Ignacio Sancho
Alicia Rico Nieto
Laura Guio Carrión
Alex Soriano Viladomiu
Laura Morata Ruiz
Francisco José de Abajo Iglesias
Publication date
15-05-2024
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Clinical Microbiology & Infectious Diseases
Print ISSN: 0934-9723
Electronic ISSN: 1435-4373
DOI
https://doi.org/10.1007/s10096-024-04838-3
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