Virginie Prendki1, Valérie Zeller2, Dorick Passeron3, Nicole Desplaces4, Patrick Mamoudy3, Jérôme Stirnemann5, Simon Marmor3, Jean-Marc Ziza6. 1. Department of Internal Medicine, Rehabilitation and Geriatrics, Hôpitaux Universitaires de Genève, Hôpital des Trois-Chêne, Chemin de Pont Bochet, 1226 Thônex, Switzerland; Department of Internal Medicine and Rheumatology, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France; Centre de Référence pour les Infections Ostéo Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France. Electronic address: virginie.prendki@hcuge.ch. 2. Department of Internal Medicine and Rheumatology, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France; Centre de Référence pour les Infections Ostéo Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France; Department of Orthopaedic Surgery, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France. 3. Centre de Référence pour les Infections Ostéo Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France; Department of Orthopaedic Surgery, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France. 4. Centre de Référence pour les Infections Ostéo Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France; Biological Laboratory, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France. 5. Department of Internal Medicine, Rehabilitation and Geriatrics, Hôpitaux Universitaires de Genève, Hôpital des Trois-Chêne, Chemin de Pont Bochet, 1226 Thônex, Switzerland. 6. Department of Internal Medicine and Rheumatology, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France; Centre de Référence pour les Infections Ostéo Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France.
Abstract
OBJECTIVES: To describe elderly patients treated with prolonged suppressive antibiotic therapy for a prosthetic joint infection (PJI) in cases where the infected prosthesis could not be removed. METHODS: All patients aged ≥80 years with a documented PJI and treated with prolonged suppressive antibiotic therapy for more than 6 months were included retrospectively in this study. The following events were noted: failure including persisting infection, relapse, new infection, treatment discontinuation due to severe adverse events, and related death, and also unrelated death. RESULTS: Thirty-eight patients with a median age of 84 years (80-95 years) were included; there were 24 hip infections, 13 knee infections, and one shoulder infection. The main causative organisms were Staphylococcus aureus (39%) and Streptococcus agalactiae (16%). The most commonly prescribed antibiotics as prolonged suppressive therapy were penicillins. The median follow-up duration was 24 months; 60% of the patients were event-free at 24 months and were still on prolonged suppressive antibiotic therapy. Fifteen events (six failures and nine unrelated deaths) were observed. Hypoalbuminaemia, the presence of a sinus tract, and a staphylococcal PJI were associated with an increased risk of an event. CONCLUSIONS: Prolonged suppressive antibiotic therapy is an alternative therapy in elderly patients with PJI when surgery is contraindicated and when the bacteria are susceptible to well-tolerated oral antimicrobial therapy such as beta-lactams.
OBJECTIVES: To describe elderly patients treated with prolonged suppressive antibiotic therapy for a prosthetic joint infection (PJI) in cases where the infected prosthesis could not be removed. METHODS: All patients aged ≥80 years with a documented PJI and treated with prolonged suppressive antibiotic therapy for more than 6 months were included retrospectively in this study. The following events were noted: failure including persisting infection, relapse, new infection, treatment discontinuation due to severe adverse events, and related death, and also unrelated death. RESULTS: Thirty-eight patients with a median age of 84 years (80-95 years) were included; there were 24 hip infections, 13 knee infections, and one shoulder infection. The main causative organisms were Staphylococcus aureus (39%) and Streptococcus agalactiae (16%). The most commonly prescribed antibiotics as prolonged suppressive therapy were penicillins. The median follow-up duration was 24 months; 60% of the patients were event-free at 24 months and were still on prolonged suppressive antibiotic therapy. Fifteen events (six failures and nine unrelated deaths) were observed. Hypoalbuminaemia, the presence of a sinus tract, and a staphylococcal PJI were associated with an increased risk of an event. CONCLUSIONS: Prolonged suppressive antibiotic therapy is an alternative therapy in elderly patients with PJI when surgery is contraindicated and when the bacteria are susceptible to well-tolerated oral antimicrobial therapy such as beta-lactams.
Authors: V Prendki; T Ferry; P Sergent; E Oziol; E Forestier; T Fraisse; S Tounes; S Ansart; J Gaillat; S Bayle; O Ruyer; F Borlot; G Le Falher; B Simorre; F-A Dauchy; S Greffe; T Bauer; E N Bell; B Martha; M Martinot; M Froidure; M Buisson; A Waldner; X Lemaire; A Bosseray; M Maillet; V Charvet; A Barrelet; B Wyplosz; M Noaillon; E Denes; E Beretti; M Berlioz-Thibal; V Meyssonnier; E Fourniols; L Tliba; A Eden; M Jean; C Arvieux; K Guignery-Kadri; C Ronde-Oustau; Y Hansmann; A Belkacem; F Bouchand; G Gavazzi; F Herrmann; J Stirnemann; A Dinh Journal: Eur J Clin Microbiol Infect Dis Date: 2017-04-04 Impact factor: 3.267
Authors: M Pradier; O Robineau; A Boucher; M Titecat; N Blondiaux; M Valette; C Loïez; E Beltrand; S Nguyen; H Dézeque; H Migaud; Eric Senneville Journal: Infection Date: 2017-10-20 Impact factor: 3.553