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What is the appropriate extended duration of antibiotic prophylaxis after two-stage revision for chronic PJI?

Xinyu Fang1, Qiaojie Wang2, Xurong Yang3

  • 1Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.

Bone & Joint Research
|December 13, 2021
PubMed
Abstract

Insights

Short-term antibiotic use after reimplantation surgery for chronic periprosthetic joint infection (PJI) effectively controls infection. This finding supports less than one month of antibiotic prophylaxis for successful two-stage revision outcomes.

Area of Science:

  • Orthopedic surgery
  • Infectious disease
  • Pharmacology

Background:

  • Chronic periprosthetic joint infection (PJI) poses a significant challenge in orthopedic surgery.
  • Two-stage revision is a common treatment for chronic PJI, involving surgical debridement and prosthesis removal followed by reimplantation.
  • The optimal duration of antibiotic prophylaxis after the reimplantation stage remains a subject of investigation.

Purpose of the Study:

  • To evaluate the impact of different antibiotic prophylaxis durations post-stage II reimplantation on the success rates of two-stage revision for chronic PJI.
  • To identify prognostic factors associated with infection recurrence after two-stage revision for chronic PJI.

Main Methods:

  • Retrospective analysis of 105 patients undergoing two-stage revision for chronic PJI between January 2010 and June 2018.
  • Patients were categorized into short-term (≤1 month) and long-term (>1 month) antibiotic prophylaxis groups post-stage II reimplantation.
  • Comparison of infection control rates and analysis of prognostic factors for recurrence using Cox regression.

Main Results:

  • The study included 105 patients (64 short-term, 41 long-term).
  • Overall infection control was achieved in 99 patients (94.3%) at a minimum 24-month follow-up.
  • No significant difference in infection control rates was observed between the short-term (95.3%) and long-term (92.7%) antibiotic groups (p=0.676).
  • Methicillin-resistant Staphylococcus infection was identified as an independent risk factor for recurrence (p=0.015).

Conclusions:

  • Antibiotic prophylaxis for less than one month following stage II reimplantation in two-stage revision for chronic PJI is effective in achieving good infection control.
  • The duration of antibiotic prophylaxis beyond one month does not appear to significantly improve infection control rates in this patient cohort.
  • Early identification and management of methicillin-resistant Staphylococcus infections are crucial for improving outcomes in chronic PJI treatment.
Keywords:
Course of antibioticsCox regression analysisPeriprosthetic joint infectionPeriprosthetic joint infection (PJI)Stage II reimplantationantibioticsantibiotics prophylaxischi-squared testhip and knee arthroplastyinfectionsprognosisreimplantation surgeryt-test

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