Short Course of Oral Antibiotic Treatment After Two-Stage Exchange Arthroplasty Appears to Decrease Early Reinfection

Area of Science:

• Orthopedic Surgery
• Infectious Disease Management
• Prosthetic Joint Infections

Background:

• Periprosthetic joint infections (PJIs) are a significant complication following arthroplasty.
• Two-stage exchange arthroplasty is a common treatment for PJIs.
• The role of extended postoperative prophylactic oral antibiotics is under investigation.

Purpose of the Study:

• To evaluate the impact of short-course oral antibiotics on reinfection rates after two-stage exchange arthroplasty for PJIs.
• To compare reinfection rates across different durations of oral antibiotic prophylaxis.

Main Methods:

• Retrospective review of 444 patients undergoing two-stage exchange arthroplasty for hip or knee PJI.
• Exclusion of patients with prior failed exchanges, positive cultures at reimplantation, or prolonged IV antibiotics.
• Categorization into three groups: no antibiotics, ≤2 weeks of oral antibiotics, and >2 weeks of oral antibiotics.

Main Results:

• The overall reinfection rate within one year was 34 cases.
• Reinfection rates were 14.1% (no antibiotics), 7.0% (≤2 weeks), and 6.4% (>2 weeks).
• A significant reduction in reinfection was observed with ≤2 weeks of oral antibiotics (HR: 0.38, P=.01) and overall with any oral antibiotic use (HR: 0.39, P=.01).

Conclusions:

• Short-course oral antibiotic prophylaxis (≤2 weeks) after two-stage exchange arthroplasty decreases the 1-year reinfection rate for PJIs.
• Further randomized trials are warranted to optimize the duration of oral antibiotic therapy.
• These findings support the use of prophylactic oral antibiotics in managing PJIs.