Suppressive antibiotic therapy in prosthetic joint infections: a multicentre cohort study

Abstract

Objectives: The aim was to describe the effectiveness of suppressive antibiotic treatment (SAT) in routine clinical practice when used in situations in which removal of a prosthetic implant is considered essential for the eradication of an infection, and it cannot be performed. Methods: This was a descriptive retrospective and multicentre cohort study of prosthetic joint infection (PJI) cases managed with SAT. SAT was considered to have failed if a fistula appeared or persisted, if debridement was necessary, if the prosthesis was removed due to persistence of the infection or if uncontrolled symptoms were present. Results: In total, 302 patients were analysed. Two hundred and three of these patients (67.2%) received monotherapy. The most commonly used drugs were tetracyclines (39.7% of patients) (120/302) and cotrimoxazole (35.4% of patients) (107/302). SAT was considered successful in 58.6% (177/302) of the patients (median time administered, 36.5 months; IQR 20.75e59.25). Infection was controlled in 50% of patients at 5 years according to KaplaneMeier analysis. Resistance development was documented in 15 of 65 (23.1%) of the microbiologically documented cases. SAT failure was associated with age <70 years (sub-hazard ratio (SHR) 1.61, 95% CI 1.1e2.33), aetiology other than Gram-positive cocci (SHR 1.56, 95% CI 1.09e2.27) and location of the prosthesis in the upper limb (SHR 2.4, 95% CI 1.5e3.84). SAT suspension was necessary due to adverse effects in 17 of 302 patients (5.6%). Conclusions: SAT offers acceptable results for patients with PJI when surgical treatment is not performed or when it fails to eradicate the infection.

Influence of biofilm growth age, media, antibiotic concentration and exposure time on Staphylococcus aureus and Pseudomonas aeruginosa biofilm removal in vitro

“…Biofilm infections such as prosthetic joint infections and chronic osteomyelitis are difficult to treat by oral or parenteral antibiotic therapy alone and debridement is needed for physical removal of biofilms [24,25]. Management of orthopedic infections often involves use of local antibiotic impregnated cement after debridement to eradicate the potentially remaining planktonic bacteria and residues of biofilms.…”

Medical innovations to maintain the function in patients with chronic PJI for whom explantation is not desirable: a pathophysiology-, multidisciplinary-, and experience-based approach

“…In patients with chronic PJI, the only way to rule out the biofilm, is to exchange the prosthesis [2,4,18]. If it is not desirable for a functional reason, the chosen strategy has to take into account that biofilm eradication (and so the cure) is not possible.…”

“…In cohort studies, the outcome (i.e. the control of the clinical signs of infection) is favorable in 30-70% of patients, depending on the patient profile, the pathogen involved, the drug used and the duration of follow-up [13][14][15][16][17][18][19][20][21]. In this context, the use of new adjuvant therapies that target locally the bacterial biofilm is of great interest as it may increase the probability of SAT to control the disease.…”

Do Prosthetic Joint Infections Worsen the Functional Ambulatory Outcome of Patients with Joint Replacements? A Retrospective Matched Cohort Study

“…On rare occasions, resection of the prosthesis, arthrodesis or amputation is performed to eradicate infection but without restoring full function. Suppressive antibiotic therapy is an option that is not intended to eradicate infection but can minimise symptoms and sometimes preserve function when it is not possible to remove the prosthesis [7].…”