Oral Antibiotics are Effective for Highly Resistant Hip Arthroplasty Infections

Abstract

Infected arthroplasties reportedly have a lower eradication rate when caused by highly resistant and/or polymicrobial isolates and in these patients most authors recommend intravenous antibiotics. We asked whether two-stage revision with interim oral antibiotics could eradicate these infections. We prospectively followed 36 patients (mean age, 71.8 years) with late hip arthroplasty infections. Combinations of oral antibiotics were prescribed according to cultures, biofilm, and intracellular effectiveness. The minimum followup was 1 year (mean, 4.4 years; range, 1-12 years). We presumed eradication in the absence of clinical, serologic, and radiographic signs of infection. Infection was eradicated in all 13 patients with highly resistant bacteria who completed a two-stage protocol (10 with methicillin-resistant Staphylococci) and in eight of 11 patients treated with only the first stage (and six of nine with methicillin-resistant Staphylococci). Infection was eradicated in six of six patients with polymicrobial isolates (of sensitive and/or resistant bacteria) who completed a two-stage protocol and in five of seven with polymicrobial isolates treated with only the first surgery. The Harris hip score averaged 88.1 (range, 70-98) in patients who underwent reimplantation and 56.8 (range, 32-76) in patients who underwent resection arthroplasty.

Reduced re-infection rates with postoperative oral antibiotics after two-stage revision hip arthroplasty

“…Previously reported success rates for two-stage revisions range from 86% to 94%, which are consistent with our findings (Table 4) [5,23,25-28]. The cohort that received postoperative oral antibiotics had no reinfections, which is comparable to the low infection rates seen by some authors in primary arthroplasty procedures [4,5,7,8].…”

“…The cohort that received postoperative oral antibiotics had no reinfections, which is comparable to the low infection rates seen by some authors in primary arthroplasty procedures [4,5,7,8]. In contrast, the cohort that did not receive postoperative oral antibiotics had a higher infection rate than the aseptic revision cohort, with the reinfection rate comparable to the reports in the literature of higher reinfection rates after two-stage revision for infected THAs [5,23,25-28]. It is uncertain what the mechanism is that leads to this difference in re-infection rates.…”

“…Additionally, Oussedik et al [17] concluded linezolid is effective for the oral treatment of infected joint arthroplasties. Other authors have noted greater difficulty when treating periprosthetic hip infections when drug-resistant pathogenic organisms, such as MRSA, are identified [6,14,23,24]. In 2008, Pulido et al [24] reported on 66 drug-resistant periprosthetic infections with either MRSA or MRSE infections with 32 undergoing two-stage revisions.…”

Remission after treatment of osteoarticular infections due to Pseudomonas aeruginosa versus Staphylococcus aureus: a case-controlled study

“…Our data suggest that the tendency towards a lower remission rate in pseudomonal osteoarticular infections cannot be compensated for by simple prolongation of post-debridement antibiotic therapy. This finding is congruent with recent retrospective data suggesting that a total antibiotic duration of maximally six weeks postdebridement [3,16,20,34], or regimens with an early switch to oral antibiotics with good oral bioavailability and bone penetration [11], are as effective as prolonged parenteral regimens [14,35]. Longer treatment durations, e.g.…”

Results after Late Polymicrobial, Gram-negative, and Methicillin-resistant Infections in Knee Arthroplasty

“…Oral antibiotics were selected according to in vitro susceptibility tests of individual bacterial isolates. Among oral antibiotics effective in vitro, we selected those with accepted activity inside biofilm and supposed activity against intracellular bacteria [1,5,6,14,[25][26][27]. Dosages were in the high range for each drug and not adjusted to individual weights (Table 3).…”