Suppressive Antibiotic Treatment in Prosthetic Joint Infections: A Perspective

Abstract

The treatment of prosthetic joint infections (PJIs) is a complex matter in which surgical, microbiological and pharmacological aspects must be integrated and, above all, placed in the context of each patient to make the best decision. Sometimes it is not possible to offer curative treatment of the infection, and in other cases, the probability that the surgery performed will be successful is considered very low. Therefore, indefinite administration of antibiotics with the intention of “suppressing” the course of the infection becomes useful. For decades, we had little information about suppressive antibiotic treatment (SAT). However, due to the longer life expectancy and increase in orthopaedic surgeries, an increasing number of patients with infected joint prostheses experience complex situations in which SAT should be considered as an alternative. In the last 5 years, several studies attempting to answer the many questions that arise on this issue have been published. The aim of this publication is to review the latest published evidence on SAT.

Effectiveness and Optimal Duration of Adjunctive Rifampin Treatment in the Management of Staphylococcus aureus Prosthetic Joint Infections After Debridement, Antibiotics, and Implant Retention

“…More importantly, Beldman et al defined receipt of chronic antibiotic suppression (CAS) as a treatment failure. CAS is a noncurative strategy to prevent PJI recurrence [ 17 , 18 ]. It is reported that more than one-third of patients aged >80 years with PJI were treated with CAS, and 60% of them were event-free at 24 months [ 19 ].…”

Chronic Suppressive Antibiotic Treatment for Staphylococcal Bone and Joint Implant–Related Infections

“…Fever and signs of sepsis were considered indicators of possible systemic spread through bacteremia. Additionally, a new positive result of the LS was considered Definitions: COAS was defined as a strategy based on a "suppressive antibiotic treatment" in which the administration of antibiotics occurs in the long term or indefinitely over time with the aim of reducing symptoms and delaying or preventing the progression of PJI in cases not eligible for standard surgical treatment [14]. Limited to COAS monitoring, a positive objectivity for one or more of these signs was considered indicative of new exacerbation and failure of COAS: severe joint pain, warmth, redness, tenderness, effusion, restricted active and passive motion, and presence of new fistula or local dehiscence or decubitus.…”

Antimicrobial treatment imprecision: an outcome-based model to close the data-to-action loop

“…54 Understanding the imprecision of flexible treatment durations adopted in the best interests of patients with recurrent or resistant infections (e.g., suppressive, prophylactic, or 'pill-in-pocket' antimicrobial plans) is difficult due to their relative rarity. [55][56][57][58]…”