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Published on: December 3, 2017
Antibiotic treatment can be safely stopped in asymptomatic patients with prosthetic joint infections despite
1Medizinische Klinik, Kantonsspital, Baslerstrasse 150, 4600 Olten, Switzerland. jpiso_ol@spital.ktso.ch
Objective:
Prosthetic joint infection should be treated for a prolonged time (3 months for hip, 6 months for knee infection). Most authors require normalization of CRP before stopping antimicrobial therapy. However, in some patients the CRP values remain slightly elevated despite adequate treatment.
Method:
We observed 14 patients with prosthetic joint infection (6 knee, 9 hip infections), in whom the CRP values never fell below the upper limit of normal. Eleven patients were surgically treated with débridement and retention of the prosthesis, in one patient one-staged reimplantation and in two patients two-staged reimplantations were performed. Antibiotic treatment was stopped according the guidelines, if the patient was clinically without signs of persistent infection and the CRP values reached a plateau, albeit above the cut-off (5 mg/L). All patients were followed for 2 years after primary diagnosis of infection.
Results:
Only one patient developed a periprosthetic infection five months after stopping antibiotic therapy. However, the isolated pathogen was different from that of the patient's first infection, so we postulate a reinfection rather than a relapse. All other patients remained free of infection for the observed period.
Conclusion:
Antibiotic treatment can safely be stopped in patients with prosthetic joint infection, even if CRP is not normalized, given that there are no clinical signs of persistent infection and a plateau of CRP level is obtained.
Insights
Antimicrobial therapy for prosthetic joint infection can be safely discontinued even with elevated C-reactive protein (CRP) levels if clinical signs of infection are absent and CRP has plateaued. This approach ensures effective treatment while managing persistent inflammatory markers.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomarkers
Background:
- Prosthetic joint infections (PJIs) necessitate prolonged antimicrobial therapy, typically 3-6 months.
- Normalization of C-reactive protein (CRP) is often a prerequisite for discontinuing antibiotic treatment.
- Persistent, mild elevation of CRP can occur despite adequate PJI treatment.
Purpose of the Study:
- To evaluate the safety and efficacy of stopping antibiotic therapy in patients with PJI when CRP levels remain elevated but stable.
- To determine if clinical recovery and CRP plateau are sufficient criteria for treatment cessation.
Main Methods:
- A cohort of 14 patients with PJI (hip and knee) and persistently elevated CRP (>5 mg/L) was observed.
- Surgical interventions included débridement with prosthesis retention or staged reimplantation.
- Antibiotic therapy was ceased based on clinical stability and a plateau in CRP levels, not normalization.
- Patients were followed for 2 years post-diagnosis.
Main Results:
- Only one patient experienced a subsequent infection, which was deemed a reinfection due to a different pathogen.
- The remaining 13 patients remained infection-free throughout the 2-year follow-up period.
- This suggests that achieving a CRP plateau is a reliable indicator for treatment cessation.
Conclusions:
- Antibiotic treatment for PJI can be safely discontinued in clinically stable patients, even if CRP levels do not normalize.
- A plateau in CRP values, alongside the absence of clinical infection signs, is a viable criterion for ending antimicrobial therapy.
- This finding challenges the strict requirement for CRP normalization in PJI treatment protocols.
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