Suppressive antibiotic therapy in prosthetic joint infections: a multicentre cohort study

R. Escudero-Sanchez*, E. Senneville, M. Digumber, A. Soriano, M. D. del Toro, A. Bahamonde, J. L. del Pozo, L. Guio, O. Murillo, A. Rico, M. J. García-País, D. Rodríguez-Pardo, J. A. Iribarren, M. Fernández, N. Benito, G. Fresco, A. Muriel, J. Ariza, J. Cobo

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

14 Citations (Scopus)

Abstract

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.

Original languageAmerican English
Pages (from-to)499-505
Number of pages7
JournalClinical Microbiology and Infection
Volume26
Issue number4
DOIs
Publication statusPublished - Apr 2020

Keywords

  • Antibiotics
  • Postoperative complications
  • Prosthesis-related infections
  • Prosthetic joint infection
  • Suppressive antibiotic treatment

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