R Escudero-Sanchez1, E Senneville2, M Digumber2, A Soriano3, M D Del Toro4, A Bahamonde5, J L Del Pozo6, L Guio7, O Murillo8, A Rico9, M J García-País10, D Rodríguez-Pardo11, J A Iribarren12, M Fernández13, N Benito14, G Fresco15, A Muriel16, J Ariza8, J Cobo15. 1. Hospital Ramón y Cajal, IRYCIS, Madrid, Spain. Electronic address: rosa.escudero0@gmail.com. 2. Centre Hospitalier Gustave Dron, Tourcoing, France. 3. Hospital Clinic, Barcelona, Spain. 4. Hospital Virgen Macarena, Sevilla, Spain. 5. Hospital El Bierzo, León, Spain. 6. Clínica Universitaria Navarra, Navarra, Spain. 7. Hospital Cruces, Vizcaya, Spain. 8. Hospital Bellvitge, Barcelona, Spain. 9. Hospital Universitario La Paz, Madrid, Spain. 10. Hospital Lucus Augusti, Lugo, Spain. 11. Hospital Vall d'Hebron, Barcelona, Spain. 12. Hospital de Donostia, Gipuzkoa, Spain. 13. Hospital de Valdecilla, Cantabria, Spain. 14. Hospital Santa Creu I Sant Pau, Barcelona, Spain. 15. Hospital Ramón y Cajal, IRYCIS, Madrid, Spain. 16. Hospital Ramón y Cajal, IRYCIS, CIBER, Madrid, Spain.
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.
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.
Authors: Rosa Escudero-Sánchez; Manuel Ponce-Alonso; Hugo Barragán-Prada; María Isabel Morosini; Rafael Cantón; Javier Cobo; Rosa Del Campo Journal: Genes (Basel) Date: 2020-12-30 Impact factor: 4.096
Authors: Hiroyuki Suzuki; Michihiko Goto; Rajeshwari Nair; Daniel J Livorsi; Poorani Sekar; Michael E Ohl; Daniel J Diekema; Eli N Perencevich; Bruce Alexander; Michael P Jones; Jennifer S McDaniel; Marin L Schweizer Journal: Open Forum Infect Dis Date: 2022-09-12 Impact factor: 4.423