How We Approach Suppressive Antibiotic Therapy Following Debridement, Antibiotics, and Implant Retention for Prosthetic Joint Infection

Abstract

The optimal treatment of prosthetic joint infection (PJI) remains uncertain. Patients undergoing debridement and implant retention (DAIR) receive extended antimicrobial treatment, and some experts leave patients at perceived highest risk of relapse on suppressive antibiotic therapy (SAT). In this narrative review, we synthesize the literature concerning the role of SAT to prevent treatment failure following DAIR, attempting to answer three key questions: 1) What factors identify patients at highest risk for treatment failure after DAIR (i.e. patients with the greatest potential to benefit from SAT)? 2) Does SAT reduce the rate of treatment failure after DAIR? And 3) What are the rates of treatment failure and adverse events necessitating treatment discontinuation in patients receiving SAT? We conclude by proposing risk-benefit stratification criteria to guide use of SAT after DAIR for PJI, informed by the limited available literature.

Role of Routine Suppressive Antibiotic Therapy After Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infections

“…Some experts recommend shared decision making in recommending SAT to patients with factors that are more subjective. These include limited surgical options, recurrent infections, difficult-to-treat pathogens, or immunosuppression [ 17 ].…”

Variation in North American Infectious Disease Specialists' Practice Regarding Oral and Suppressive Antibiotics for Adult Osteoarticular Infections: Results of an Emerging Infections Network (EIN) Survey

“…While adoption of secondary antibiotic prophylaxis after exchange arthroplasty remains limited, we found that clinicians often use long-term, frequently lifelong, SAT after DAIR or single-stage exchange. This practice, while mentioned as an option in the 2013 IDSA PJI guidelines, is based on limited, methodologically heterogenous, and confounded observational data [ 22 ]. Prolonged antibiotic exposure can lead to adverse events and the emergence of resistant pathogens.…”

Natural blackcurrant extract contained gelatin hydrogel with photothermal and antioxidant properties for infected burn wound healing

“…These infections can result in further deterioration, delayed healing, heightened pain, and additional complications [ [4] , [5] , [6] ]. Currently, various clinical strategies are employed to treat burn wound infections, including antibiotic treatment [ [7] , [8] , [9] ], surgical interventions [ 10 ], photothermal therapy [ 11 ], as well as the use of wound dressings and coverings. While antibiotic treatment is necessary in certain cases, it is essential to consider its drawbacks and limitations [ 12 ].…”