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Continuous Antibiotic Therapy Can Reduce Recurrence of Prosthetic Joint Infection in Patients Undergoing 2-Stage Exchange

Published:December 19, 2018DOI:https://doi.org/10.1016/j.arth.2018.12.017

      Abstract

      Background

      Reimplantation microbiology and serum C-reactive protein have low diagnostic accuracy in predicting recurrence in patients with prosthetic joint infection (PJI) undergoing 2-stage exchange. We aimed at identifying factors relating to failure and comparing effect of continuous antibiotic therapy versus a holiday antibiotic period pre-reimplantation.

      Methods

      This observational study included patients with PJI undergoing 2-stage exchange. Group A patients did not discontinue antibiotic treatment pre-reimplantation; in group B patients, antibiotic treatment was followed with 2 weeks of holiday antibiotic period pre-reimplantation. We defined cure as absence of recurrence for 96 weeks post-reimplantation. Statistical analyses were performed using Mann-Whitney U test, Fisher exact test, and multivariate analysis.

      Results

      We evaluated 196 patients with PJI (median age, 66 years [interquartile range, 59-72], 91 [46%] males). Comorbidity was reported in 77 (39%), and microbiologic evidence was obtained in 164 (84%). Staphylococcus aureus was isolated in 63 of 164 (38%) patients; coagulase-negative staphylococci were isolated in 71 of 164 (43%). Favorable outcome was achieved for 169 (86%) patients (91% and 79% in groups A and B, respectively). No immunocompromise (odds ratio [OR], 2.73; 95% confidence interval [CI], 1.3-7.3; P = .04), a positive culture (OR, 3.96; 95% CI, 1.55-10.19; P = .02), and no antibiotic discontinuation (OR, 3.32; 95% CI, 1.3-8.44; P = .02) predicted favorable outcome using multivariate analysis.

      Conclusion

      Treatment with continuous antibiotic therapy ameliorated success rate, permitting a better outcome in immunocompromised and reducing the time to reimplantation. Continuous antibiotic therapy can be considered a valid option for the treatment of patients with PJI undergoing 2-stage exchange.

      Level of evidence

      Therapeutic level II.

      Keywords

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