Clinical Outcome of Antibiotic Suppressive Therapy in Patients with a Prosthetic Joint Infection after Hip Replacement

Abstract

Abstract. Introduction: In Specific cases, curative treatment of a prosthetic joint infection (PJI) cannot be accomplished due to the increased risk of major complications after prosthetic joint revision surgery. In these patients, antibiotic suppressive therapy (AST) is often used to control the infection.Aim: To describe the clinical outcome of patients with a PJI after hip replacement treated with AST.Methods: Patients in which AST for PJI was started between 2006 and 2013, were retrospectively included. Follow-up was continued until October 2018. AST has been defined as treatment with oral antibiotic therapy intended to suppress PJI. Treatment was considered successful in patients without reoperation for PJI or death related to PJI during follow-up.Results: Twenty-three patients were included. The most commonly used antibiotics were doxycycline (n=14) and cotrimoxazole (n=6). The mean duration of AST was 38 months (1-151 months). AST was considered successful in 13 patients (56.5%) after a median follow-up of 33 months. AST was least successful in PJI caused by S. aureus with 80% failures versus 33% in PJI caused by other microorganisms and in patients who had an antibiotic-free period before the start of AST with 83% failures. Two patients ended AST due to side effects.Conclusion: AST can be an alternative treatment in selected patients with a PJI after hip replacement. However, there is a persisting and considerable amount of failures, particularly in PJI caused by S. aureus and in patient with an antibiotic-free period before the start of AST.

Clinical use of linezolid in periprosthetic joint infections – a systematic review

“…Linezolid offers the advantage of very good, oral bioavailability (Thompson et al, 2017) and its broad spectrum against Gram-positive bacteria facing current resistance patterns (Deroche et al, 2019;Lourtet-Hascoet et al, 2018) of organisms encountered in the treatment of PJI. Based on the reports available and included in this review a remission of the infection can be expected in around 80 % of cases.…”

“…The optimal antibiotic treatment length in PJI is currently unknown (Aboltins et al, 2019). However, long-term or life-long treatment algorithms were recommended by some guidelines and authors (Leijtens et al, 2019;Osmon et al, 2013b;Calabro et al, 2019;Aboltins et al, 2019), and duration of treatment might play a vital role (Tattevin et al, 2006) -raising the question of whether linezolid, given its adverse effects, is a potential option for long-term treatment or even suppression. In a study on chronic infections not limited to orthopedic infections, Vazquez et al (2016) concluded that with monitoring of adverse effects, a long-term treatment of greater than 6 weeks can be safely performed.…”

“…The treatment of periprosthetic joint infection (PJI) includes different surgical approaches involving debridement and prosthesis retention as well as one-stage exchange or twostage exchange, and medical systemic treatment can vary greatly regarding length and substances used (Osmon et al, 2013b;Anemuller et al, 2019;de Beaubien et al, 2019) with successful shorter-term courses (Winkler et al, 2019) described as being contrasted by long-time antibiotic suppression treatment in severe, complicated cases (Siqueira et al, 2015;Wouthuyzen-Bakker et al, 2017;Leijtens et al, 2019). Furthermore, microbiological results are changing with increasing prevalence of resistant strains (Drago et al, 2017;De Vecchi et al, 2018), particularly methicillinresistant (MR) coagulase-negative Staphylococcus (CoNS) now being the main pathogen detected (Lourtet-Hascoet et al, 2018;Hipfl et al, 2019;Tevell et al, 2019). In this context, linezolid is a potential antimicrobial treatment option addressing resistant Staphylococcus (Deroche et al, 2019) as well as reducing the need for long-term inpatient treatment given its excellent oral bioavailability (Kutscha-Lissberg et al, 2003).…”

Suppressive Antibiotic Treatment in Prosthetic Joint Infections: A Perspective

“…Few studies have analysed the factors associated with SAT failure. The failure rate seems higher among patients with a sinus tract and in those with infections caused by S. aureus [ 13 , 20 , 21 , 22 ].…”

Long-Term Impact of Suppressive Antibiotic Therapy on Intestinal Microbiota

“…Managing this situation, including the surgical and nonsurgical approaches, is complex. A curative approach is not possible for a small proportion of patients, whose only option for controlling symptoms and maintaining functionality is the indefinite administration of antibiotics, also know as suppressive antibiotic therapy (SAT), an apparently safe and well-tolerated treatment [ 3 , 4 , 5 , 6 ]. The antimicrobial impact of SAT is not limited to the infection site; one of the most concerning adverse effect is the disturbance of the commensal gut microbiota.…”