Nora Renz1, Anastasia Rakow2, Michael Müller2, Carsten Perka2, Andrej Trampuz2. 1. Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, D-10117 Berlin, Germany. Electronic address: nora.renz@charite.de. 2. Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, D-10117 Berlin, Germany.
Abstract
OBJECTIVES: To evaluate the effect of oral antimicrobial suppression on the outcome of streptococcal periprosthetic joint infection (PJI). METHODS: Consecutive patients with streptococcal PJI receiving antimicrobial suppression for >6 months were prospectively included and compared to a retrospective control group without suppression. Outcome was assessed with Kaplan-Meier analysis and compared by the log-rank Mantel-Cox test. Multivariate analysis was used to identify factors associated with treatment failure. RESULTS: Of 69 streptococcal PJI episodes (37 knee, 31 hip and one shoulder PJI), 43 (62%) were caused by beta-hemolytic streptococci and 26 (38%) by viridans group streptococci. Debridement and prosthesis retention was performed in 27 (39%), one-stage exchange in 5 (7%), multi-stage exchange in 31 (44%) and prosthesis removal in 6 patients (9%). 24 patients (35%) were treated with antimicrobial suppression receiving oral amoxicillin (n = 22), doxycycline (n = 1) or clindamycin (n = 1). After a median follow-up of 13 months (range, 0.5-111 months), 38 of 65 patients (58%) were infection-free. Suppressive antimicrobial treatment was associated with higher success rate compared with no suppression (93% vs. 57%, p = 0.002), representing the only significant independent factor preventing treatment failure. CONCLUSIONS: Long-term antimicrobial suppression was associated with significantly better treatment outcome and should be strongly considered in streptococcal PJI.
OBJECTIVES: To evaluate the effect of oral antimicrobial suppression on the outcome of streptococcal periprosthetic joint infection (PJI). METHODS: Consecutive patients with streptococcal PJI receiving antimicrobial suppression for >6 months were prospectively included and compared to a retrospective control group without suppression. Outcome was assessed with Kaplan-Meier analysis and compared by the log-rank Mantel-Cox test. Multivariate analysis was used to identify factors associated with treatment failure. RESULTS: Of 69 streptococcal PJI episodes (37 knee, 31 hip and one shoulder PJI), 43 (62%) were caused by beta-hemolytic streptococci and 26 (38%) by viridans group streptococci. Debridement and prosthesis retention was performed in 27 (39%), one-stage exchange in 5 (7%), multi-stage exchange in 31 (44%) and prosthesis removal in 6 patients (9%). 24 patients (35%) were treated with antimicrobial suppression receiving oral amoxicillin (n = 22), doxycycline (n = 1) or clindamycin (n = 1). After a median follow-up of 13 months (range, 0.5-111 months), 38 of 65 patients (58%) were infection-free. Suppressive antimicrobial treatment was associated with higher success rate compared with no suppression (93% vs. 57%, p = 0.002), representing the only significant independent factor preventing treatment failure. CONCLUSIONS: Long-term antimicrobial suppression was associated with significantly better treatment outcome and should be strongly considered in streptococcal PJI.
Authors: Karolin Köder; Sebastian Hardt; Max S Gellert; Judith Haupenthal; Nora Renz; Michael Putzier; Carsten Perka; Andrej Trampuz Journal: Infection Date: 2020-05-05 Impact factor: 3.553
Authors: Octavian Andronic; Yvonne Achermann; Thorsten Jentzsch; Flurin Bearth; Andreas Schweizer; Karl Wieser; Sandro F Fucentese; Stefan Rahm; Annelies S Zinkernagel; Patrick O Zingg Journal: Int Orthop Date: 2020-08-27 Impact factor: 3.075