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European Journal of Orthopaedic Surgery & Traumatology

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01-02-2020 | Doxycycline | Original Article • KNEE - ARTHROPLASTY

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

Authors: N. A. Sandiford, J. R. Hutt, D. O. Kendoff, P. A. Mitchell, M. Citak, L. Granger

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 2/2020

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.

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

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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

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

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 CrossRef

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

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

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

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 CrossRefPubMedPubMedCentral

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):373–383CrossRefPubMed

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 CrossRef

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 CrossRefPubMedPubMedCentral

14.

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

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMed

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 CrossRefPubMed

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 CrossRefPubMedPubMedCentral

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 CrossRefPubMedPubMedCentral

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):1577–1585CrossRefPubMed

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):3106–3114CrossRefPubMed

Title: Prolonged suppressive antibiotic therapy is successful in the management of prosthetic joint infection
Authors: N. A. Sandiford
J. R. Hutt
D. O. Kendoff
P. A. Mitchell
M. Citak
L. Granger
Publication date: 01-02-2020
Publisher: Springer Paris
Keywords: Doxycycline
Antibiotic
Amoxicillin
Joint Infection
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 2/2020
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-019-02559-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Introduction

Methods

Results

Discussion and conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Discussion and conclusion

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