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Continuous Antibiotic Therapy Can Reduce Recurrence of Prosthetic Joint Infection in Patients Undergoing 2-Stage

Tiziana Ascione1, Giovanni Balato2, Massimo Mariconda2

  • 1Department of Infectious Diseases, D. Cotugno Hospital, AORN Dei Colli, Naples, Italy.

The Journal of Arthroplasty
|January 23, 2019
PubMed
Abstract

Insights

Continuous antibiotic therapy improved success rates for prosthetic joint infection (PJI) patients undergoing two-stage exchange. This approach is a viable option, especially for immunocompromised individuals, reducing reimplantation time.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Surgical Innovation

Background:

  • Prosthetic joint infection (PJI) recurrence prediction is challenging using standard microbiology and C-reactive protein levels.
  • Two-stage exchange is a common surgical approach for PJI management.
  • Identifying factors influencing treatment failure is crucial for optimizing outcomes.

Purpose of the Study:

  • To identify factors associated with treatment failure in patients with PJI undergoing two-stage exchange.
  • To compare the efficacy of continuous antibiotic therapy versus antibiotic holidays before reimplantation.

Main Methods:

  • An observational study involving 196 patients with PJI undergoing two-stage exchange.
  • Group A received continuous antibiotics; Group B had a two-week antibiotic holiday pre-reimplantation.
  • Cure was defined as absence of recurrence for 96 weeks post-reimplantation; statistical analysis included Mann-Whitney U, Fisher exact, and multivariate analyses.

Main Results:

  • A favorable outcome was achieved in 86% of patients (91% in Group A vs. 79% in Group B).
  • Multivariate analysis identified no immunocompromise, positive intraoperative culture, and antibiotic discontinuation as predictors of unfavorable outcomes.
  • Staphylococcus aureus and coagulase-negative staphylococci were the most common pathogens.

Conclusions:

  • Continuous antibiotic therapy demonstrated a higher success rate in treating PJI patients undergoing two-stage exchange.
  • This approach offers benefits for immunocompromised patients and potentially reduces the time to reimplantation.
  • Continuous antibiotic therapy is a valid treatment option for PJI requiring two-stage exchange.
Keywords:
2-stagecontinuous therapydiagnosisinfectionprosthetic joint infectionstreatment

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