G Chieffo1, S Corsia2, G Rougereau2, M Enser3, L J Eyrolle3, S Kernéis4, P Morand5, J Loubinoux5, R Gauzit3, P Leclerc2, P Wipff6, Y Allanore6, P Anract2, D Salmon7. 1. Infectious Diseases and Tropical Medicine Department, AP-HP, Cochin Hôtel-Dieu, Paris Descartes University, Paris, France; Infectious Diseases and Tropical Medicine Department, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy. Electronic address: chieffogabriella@gmail.com. 2. Orthopedic Surgery Department, AP-HP, Cochin Hospital, Paris Descartes University, Paris, France. 3. Department of Anesthesiology, Infectious Diseases Unit, AP-HP, Cochin Hospital, Paris Descartes University, Paris, France. 4. Infectious Diseases and Tropical Medicine Department, AP-HP, Cochin Hôtel-Dieu, Paris Descartes University, Paris, France. 5. Department of Bacteriology, HUPC, Cochin Hospital, Paris Descartes University, Paris, France. 6. Rheumatology Department, AP-HP, Cochin Hôtel-Dieu, Paris Descartes University, Paris, France. 7. Infectious Diseases and Tropical Medicine Department, AP-HP, Cochin Hôtel-Dieu, Paris Descartes University, Paris, France. Electronic address: dominique.salmon@aphp.fr.
Abstract
OBJECTIVES: One-stage replacement arthroplasty for treatment of periprosthetic joint infection (PJI) results in similar cure rate than two-stage (around 85-92%), but antibiotic therapy duration is not well established. The aim of this study was to evaluate the efficacy of a short six-week antibiotic course in periprosthetic joint infections after onstage exchange. PATIENTS AND METHODS: Retrospective, observational study conducted at Orthopaedic Department of Cochin Hospital, Paris, between 1st January 2010 and 31 December 2015. Patients with a microbiologically proven PJI, treated with one-stage replacement and 6 weeks (+/1week) of antimicrobial therapy were included. Pearson's-χ2 and Wilcoxon tests were used to compare categorical and continuous variables. RESULTS: Fifty patients with periprosthetic joint infections (42 hip, 8 knee PJI) treated with one-stage replacement arthroplasty were included. Median age was 69.3 years (IQR 24.5-97.4). Infections occurred after a mean of 36 months (IQR 1-216). Bone biopsy cultures were positive for Staphylococcus spp. in 29 patients (58%), Cutibacterium acnes in 19 (38%), Gram-negative bacilli in 6 (12%). Polymicrobial infections occurred in 12 (24%). Intravenous antibiotics were administered for a median of 11 days (IQR 4-45) and 46 patients (92%) were switched to an oral therapy. Medium follow-up was of 32 months (IQR 12-101). Overall remission rate was 90%. CONCLUSIONS: A six-week course of antibiotics in knee and hip PJIs treated with one-stage RA has a satisfactory remission rate in this open study.
OBJECTIVES: One-stage replacement arthroplasty for treatment of periprosthetic joint infection (PJI) results in similar cure rate than two-stage (around 85-92%), but antibiotic therapy duration is not well established. The aim of this study was to evaluate the efficacy of a short six-week antibiotic course in periprosthetic joint infections after onstage exchange. PATIENTS AND METHODS: Retrospective, observational study conducted at Orthopaedic Department of Cochin Hospital, Paris, between 1st January 2010 and 31 December 2015. Patients with a microbiologically proven PJI, treated with one-stage replacement and 6 weeks (+/1week) of antimicrobial therapy were included. Pearson's-χ2 and Wilcoxon tests were used to compare categorical and continuous variables. RESULTS: Fifty patients with periprosthetic joint infections (42 hip, 8 knee PJI) treated with one-stage replacement arthroplasty were included. Median age was 69.3 years (IQR 24.5-97.4). Infections occurred after a mean of 36 months (IQR 1-216). Bone biopsy cultures were positive for Staphylococcus spp. in 29 patients (58%), Cutibacterium acnes in 19 (38%), Gram-negative bacilli in 6 (12%). Polymicrobial infections occurred in 12 (24%). Intravenous antibiotics were administered for a median of 11 days (IQR 4-45) and 46 patients (92%) were switched to an oral therapy. Medium follow-up was of 32 months (IQR 12-101). Overall remission rate was 90%. CONCLUSIONS: A six-week course of antibiotics in knee and hip PJIs treated with one-stage RA has a satisfactory remission rate in this open study.
Keywords:
Infections ostéoarticulaires sur prothèse; One-stage replacement; Periprosthetic joint infections; Replacement arthroplasty; Reprise en un temps; Reprise totale de prothèse