Predictors of Success with Chronic Antibiotic Suppression for Prosthetic Joint Infections. Journal Article

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Authors: Burr, RG; Eikani, C; Adams, WH; Hopkinson, WJ; Brown, NM
Article Title: Predictors of Success with Chronic Antibiotic Suppression for Prosthetic Joint Infections.
Abstract: INTRODUCTION: Management of recurrent prosthetic joint infection (PJI) after attempted surgical eradication remains a challenge. Chronic antibiotic suppression (CAS) is regarded as a reasonable treatment option for select patients with persistent infection or multiple co-morbidities. The study seeks to compare cohorts who succeed and fail with CAS. METHODS: This retrospective cohort study assesses patients who were treated with CAS for a PJI. Patients were included if they had a culture-proven PJI and received chronic suppressive antibiotics. Failure of suppression was defined as reoperation after initiating CAS or death occurring as result of infection. A cox-proportional hazards multivariate regression model was used to estimate risk of reoperation as a function of risk factors related to patient comorbidities, surgical history, affected joint, and infecting organism. RESULTS: We identified 45 PJIs (31 knees, 14 hips) managed with CAS with a median follow-up of 50 (95% CI: 33.61-74.02) months. The overall success rate of managing PJI with CAS was 67% (30/45). Controlling for BMI and gram status of the organism, THA patients were less likely than TKA patients to require reoperation (HR=0.18, 95% CI: 0.01-0.96; p=.04). Patients with gram-positive infections were less likely than those with a gram-negative infections to require reoperation (HR=0.22, 95% CI: 0.05-0.88; p=.03). Severe antibiotic side effects were rare. Patients who experienced multiple changes to their antibiotic regimen were more likely to fail with CAS. CONCLUSION: CAS is a reasonable strategy in patients with PJI who lack or refuse further surgical treatment options. Most hips and gram-positive infections treated with CAS successfully avoided reoperation in this cohort.
Journal Title: The Journal of arthroplasty
ISSN: 1532-8406; 0883-5403
Publisher: Unknown  
Date Published: 2022