TY - JOUR
T1 - Suppressive antibiotic therapy in prosthetic joint infections
T2 - a multicentre cohort study
AU - Escudero-Sanchez, R.
AU - Senneville, E.
AU - Digumber, M.
AU - Soriano, A.
AU - del Toro, M. D.
AU - Bahamonde, A.
AU - del Pozo, J. L.
AU - Guio, L.
AU - Murillo, O.
AU - Rico, A.
AU - García-País, M. J.
AU - Rodríguez-Pardo, D.
AU - Iribarren, J. A.
AU - Fernández, M.
AU - Benito, N.
AU - Fresco, G.
AU - Muriel, A.
AU - Ariza, J.
AU - Cobo, J.
N1 - Funding Information:
Participation in this study was offered to researchers associated with the ESGIAI (European ESCMID Study Group for Implant Infections) of the ESCMID (European Society of Clinical Microbiology and Infectious Diseases) and to the Study Group on Osteoarticular Infections (Grupo de Estudio de Infecciones Osteoarticulares, GEIO) of the Spanish Society for Infectious Diseases and Clinical Microbiology (Sociedad Espa?ola de Enfermedades Infecciosas y Microbiolog?a Cl?nica, SEIMC). This study was conducted thanks to the collaboration of the REIPI (Spanish Network for Research in Infectious Diseases), GEIO and ESGIAI (European Study Group for Implant-associated Infection). We thank Andr?s Chornogubsky Clerici for providing help with the electronic database. This study was conducted thanks also to the following collaborators: C. Pe?as. H. Virgen del Roc?o, Sevilla (Spain), A. Ribera. Hospital Bellvitge, Barcelona (Spain), J. Corredoira. Hospital Lucis Augusti de Lugo, Lugo (Spain), M. Fari?as. Hospital de Valcecilla, Santander (Spain), C. Pigrau. Hospital Santa Creu I Sant Pau, Barcelona (Spain), P. Coll. Hospital Santa Creu I Sant Pau, Barcelona (Spain), Z. Kocak. Ankara Hospital, Ankara (Turkey), J. Palomino. Hospital Virgen del Roc?o, Sevilla (Spain), J. Lora. Hospital Doce de Octubre, Madrid (Spain), R. Trebse. Hospital Valdoltra Slovenia (Slovenia), A. J?ver. Hospital Arnau de Vilanova, Lleida (Spain), A. Espigares. Hospital Gomez Ulla, Madrid (Spain), M. Riera. Hospital Son Espases, Mallorca (Spain), T. Ascione. Cotugno Hospital, Napoles (Italy), M. Sanchez-Somolinos. Hospital Gregorio Mara??n, Madrid (Spain), A. Ramos. Hospital Puerta de Hierro, Madrid (Spain), C. Pensotti. Cl?nica Monte Grande, Buenos Aires (Argentina), L. G?mez. Hospital Mutua de Tarrasa, Barcelona (Spain), N. O'Conell. University Hospital Limerick, Limerick (Ireland). No external funding was received. Dr. Senneville reports the receipt of personal fees and non-financial support from Bayer, Sanofi-aventis, Pfizer, MSD, Correvio, Urgo, M?lnycke and Shionogi. Dr. del Pozo reports the receipt of personal fees related to participation in scientific conferences from MSD, Pfizer and Astellas. Dr. Benito reports the receipt of non-financial support from Pfizer, Astellas, MSD, Novartis, Astra-Zeneca and Angellini. No conflicts of interest were reported by any of the other authors.
Publisher Copyright:
© 2019 European Society of Clinical Microbiology and Infectious Diseases
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/4
Y1 - 2020/4
N2 - 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 20.75–59.25). Infection was controlled in 50% of patients at 5 years according to Kaplan–Meier 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 1.1–2.33), aetiology other than Gram-positive cocci (SHR 1.56, 95% CI 1.09–2.27) and location of the prosthesis in the upper limb (SHR 2.4, 95% CI 1.5–3.84). 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.
AB - 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 20.75–59.25). Infection was controlled in 50% of patients at 5 years according to Kaplan–Meier 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 1.1–2.33), aetiology other than Gram-positive cocci (SHR 1.56, 95% CI 1.09–2.27) and location of the prosthesis in the upper limb (SHR 2.4, 95% CI 1.5–3.84). 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.
KW - Antibiotics
KW - Postoperative complications
KW - Prosthesis-related infections
KW - Prosthetic joint infection
KW - Suppressive antibiotic treatment
UR - http://www.scopus.com/inward/record.url?scp=85074415661&partnerID=8YFLogxK
U2 - 10.1016/j.cmi.2019.09.007
DO - 10.1016/j.cmi.2019.09.007
M3 - Artículo
C2 - 31539638
AN - SCOPUS:85074415661
SN - 1198-743X
VL - 26
SP - 499
EP - 505
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 4
ER -