The Role of Long-Term Antibiotic Suppression in the Management of Peri-Prosthetic Joint Infections Treated With Debridement, Antibiotics, and Implant Retention: A Systematic Review

Malahias, Michael‐Alexander; Gu, Alex; Harris, Evan; Adriani, Marco; Miller, Andy O.; Westrich, Geoffrey H.; Sculco, Peter K.

doi:10.1016/j.arth.2019.11.026

Cited by 35 publications

(27 citation statements)

References 18 publications

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“…Few studies have analysed the factors associated with SAT failure. The failure rate seems higher among patients with a sinus tract and in those with infections caused by S. aureus [ 13 , 20 , 21 , 22 ].…”

Section: Evidence On Sat Efficacymentioning

confidence: 99%

“…It seems reasonable to think that the reduction in the inoculum and the debridement of infected tissues favours the success of SAT. In most of the series, patients undergo debridement surgery before starting SAT [ 21 ]. The difficulty arises in stable patients who present few symptoms, especially if the surgical risks are high.…”

Section: Practical Aspects Of Satmentioning

confidence: 99%

“…In SAT series, adverse effects are not uncommon, but they rarely require discontinuation of treatment [ 19 , 21 , 22 ]. In addition, in many cases, poorly tolerated antibiotics can be substituted for another [ 10 , 17 ].…”

Section: Safety Of Satmentioning

confidence: 99%

“…It should be borne in mind that in most series, ID consultants with extensive experience in the management of antimicrobials are those who prescribe and monitor treatments. Surprisingly, C. difficile infection is an infrequent event despite very long treatments that last many years [ 19 , 21 ].…”

Section: Safety Of Satmentioning

confidence: 99%

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Suppressive Antibiotic Treatment in Prosthetic Joint Infections: A Perspective

Cobo

Escudero-Sánchez

2021

Antibiotics

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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.

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Section: Evidence On Sat Efficacymentioning

confidence: 99%

Section: Practical Aspects Of Satmentioning

confidence: 99%

Section: Safety Of Satmentioning

confidence: 99%

Section: Safety Of Satmentioning

confidence: 99%

See 2 more Smart Citations

Suppressive Antibiotic Treatment in Prosthetic Joint Infections: A Perspective

Cobo

Escudero-Sánchez

2021

Antibiotics

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Ferry

Batailler

Brosset

et al. 2020

SICOT-J

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Introduction: PJI is the most dramatic complication after joint arthroplasty. In patients with chronic infection, prosthesis exchange is in theory the rule. However, this surgical approach is sometimes not desirable especially in elderly patients with multiple comorbidities, as it could be associated with a dramatic loss of function, reduction of the bone stock, fracture, or peroperative death. We propose here to report different approaches that can help to maintain the function in such patients based on a pathophysiology-, multidisciplinary-, and an experience-based approach. Methods: We describe the different points that are needed to treat such patients: (i) the multidisciplinary care management; (ii) understanding the mechanism of bacterial persistence; (iii) optimization of the conservative surgical approach; (iv) use of suppressive antimicrobial therapy (SAT); (v) implementation of innovative agents that could be used locally to target the biofilm. Results: In France, a nation-wide network called CRIOAc has been created and funded by the French Health ministry to manage complex bone and joint infection. Based on the understanding of the complex pathophysiology of PJI, it seems to be feasible to propose conservative surgical treatment such as “debridement antibiotics and implant retention” (with or without soft-tissue coverage) followed by SAT to control the disease progression. Finally, there is a rational for the use of particular agents that have the ability to target the bacteria embedded in biofilm such as bacteriophages and phage lysins. Discussion: This multistep approach is probably a key determinant to propose innovative management in patients with complex PJI, to improve the outcome. Conclusion: Conservative treatment has a high potential in patients with chronic PJI for whom explantation is not desirable. The next step will be to evaluate such practices in nation-wide clinical trials.

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