The efficacy of suppressive antibiotic treatment in patients managed non-operatively for  periprosthetic joint infection and  a draining sinus

Lensen, K. D. F.; Escudero-Sánchez, Rosa; Cobo, Javier; Trebše, Rihard; Gubavu, C.; Tedeschi, Sara; Lomas, José Manuel; Arvieux, Cédric; Rodríguez-Pardo, Dolors; Fantoni, Massimo; País, María José García; Jover, Federico Blanco; Salles, Mauro José Costa; Sancho, Ignacio; Sampedro, Marta Fernández; Soriano, Álex; Wouthuyzen-Bakker, Marjan

doi:10.5194/jbji-6-313-2021

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…Indeed, no patient in our cohort had this condition at baseline. This is of relevance, considering that COAS appears to have limited utility in the presence of a sinus [44].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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Prosthetic joint infection (PJI) and fracture-related infection (FRI) are difficult-to-treat conditions in patients with severe comorbidity or significant surgical risk. In cases not eligible for standard strategy, debridement procedures with the retention of prosthesis or internal fixation device, combined with long-term antibiotic treatment and subsequent indefinite chronic oral antimicrobial suppression (COAS), can be the only reasonable choice. The aim of this study was to investigate the role of COAS and its follow-up in the management of these cases. We retrospectively analyzed a cohort of 16 patients with a follow-up of at least 6 months (mean age 75 yo, 9F, 7M, 11 PJI, 5 FRI). All microbiological isolates were tetracycline-susceptible staphylococci and for this reason a minocycline-based COAS was adopted after debridement and 3 months of antibiogram-guided antibiotic treatment. Patient monitoring was carried out on a clinical basis, with bimonthly execution of the inflammation indices and serial radiolabeled leukocyte scintigraphy (LS). The overall median time of COAS follow-up was 15 months (min 6–max 30). Moreover, 62.5% of patients were still taking COAS with no relapse after cure at the last evaluation available. Clinical failure with a relapse of the infection was observed in 37.5% of patients; interestingly, 50% of them had previously stopped COAS due to side effects of the antibiotic used. In the COAS follow-up, a combination of clinical, laboratory and LS evaluation seems to monitor the infection properly. COAS can be considered as an interesting approach in patients not suitable for standard treatments of PJI or FRI but it requires careful monitoring.

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“…Indeed, no patient in our cohort had this condition at baseline. This is of relevance, considering that COAS appears to have limited utility in the presence of a sinus [44].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…Chronic antimicrobial suppressive therapy is a viable treatment option in patients who are poor candidates for extensive surgery. Suppressive antibiotic therapy in PJI following elective hip and knee arthroplasty has shown implant retention rates of up to 85%, as well as decreased pain scores [74][75][76] .…”

Section: Surgical Managementmentioning

confidence: 99%

Management of Periprosthetic Joint Infections After Hemiarthroplasty of the Hip

et al. 2022

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Periprosthetic joint infection (PJI) following hip hemiarthroplasty (HA) is a devastating complication, incurring immense health-care costs associated with its treatment and placing considerable burden on patients and their families. These patients often require multiple surgical procedures, extended hospitalization, and prolonged antimicrobial therapy.» Notable risk factors include older age, higher American Society of Anesthesiologists (ASA) score, inadequate antibiotic prophylaxis, non-antibiotic-loaded cementation of the femoral implant, longer duration of the surgical procedure, and postoperative drainage and hematoma.» Although the most frequent infecting organisms are gram-positive cocci such as Staphylococcus aureus, there is a higher proportion of patients with gram-negative and polymicrobial infections after hip HA compared with patients who underwent total hip arthroplasty. » Several surgical strategies exist. Regardless of the preferred surgical treatment, successful management of these infections requires a comprehensive surgical debridement focused on eradicating the biofilm followed by appropriate antibiotic therapy.

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The Use of Long-term Antibiotics for Suppression of Bacterial Infections

Horne,

Woolley,

Lau

2024

Clinical Infectious Diseases

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Suppressive antibiotic therapy is prescribed when a patient has an infection that is presumed to be incurable by a defined course of therapy or source control. The cohort receiving suppressive antibiotic therapy is typically highly comorbid and the infections often involve retained prosthetic material. In part due to a lack of clear guidelines regarding the use of suppressive antibiotics, and in part due to the complex nature of the infections in question, patients are often prescribed suppressive antibiotics for extremely long, if not indefinite, courses. The risks of prolonged antibiotic exposure in this context are not fully characterised, but they include adverse drug effects ranging from mild to severe, the development of antibiotic resistant organisms and perturbations of the gastrointestinal microbiome. In this narrative review we present the available evidence for the use of suppressive antibiotic therapy in four common indications, examine the gaps in the current literature and explore the known and potential risks of this therapy. We also make suggestions for improving the quality of evidence in future studies, particularly by highlighting the need for a standardised term to describe the use of long-courses of antibiotics to suppress hard-to-treat infections.

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The efficacy of suppressive antibiotic treatment in patients managed non-operatively for periprosthetic joint infection and a draining sinus

Cited by 3 publications

References 15 publications

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

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

Management of Periprosthetic Joint Infections After Hemiarthroplasty of the Hip

The Use of Long-term Antibiotics for Suppression of Bacterial Infections

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