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Published on: December 3, 2017
Two-Stage Revision Arthroplasty for Resistant Gram-Positive Periprosthetic Joint Infections Using an Oral
Lars Gründer1, Sebastian Bockholt1, Georg Gosheger1
1Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
Background:
Increasing antibiotic resistance has been reported as an issue in the systemic treatment of periprosthetic joint infection (PJI). Linezolid offers the advantages of high oral bioavailability and little resistance; however, efficacy in the treatment of PJI varies considerably, and studies reporting consistent surgical treatment are scarce.
Methods:
This is a retrospective, single-center analysis of two-stage revisions performed between 2008 and 2017. We identified 111 patients who met the inclusion criteria. Oral linezolid was given for 28 days following 14 days of intravenous tailored antibiotics in resistant gram-positive PJI. A total of 64% of the patients had methicillin-resistant coagulase-negative staphylococci. The median follow-up was 43 (interquartile range (IQR) 30-57) months.
Results:
22% (24/111) of the patients underwent surgery for subsequent infection. The 5-year infection-free survival probability was 77% (95% confidence interval (CI) 69-85). A total of 5% of the patients (6/111) had the same organism at the time of reinfection. The patients with infections caused by other organisms than Coagulase-negative staphylococci tended to have a worse reinfection-free survivorship at five years (70% vs. 81%, p = 0.09). Furthermore, the patients with obesity tended to have reduced reinfection-free survivorship at five years (69% vs. 84%, p = 0.08). Overall, 5% (6/111) of the patients had blood count abnormalities with no treatment discontinuations.
Conclusion:
Two-stage revision arthroplasty with systemic oral linezolid treatment for resistant gram-positive PJI results in an infection control of 77% at the mid-term.
Insights
Oral linezolid combined with two-stage revision surgery achieved 77% infection control for resistant gram-positive periprosthetic joint infection (PJI) at five years. This treatment shows promise for managing challenging PJI cases.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Pharmacology
Background:
- Antibiotic resistance is a growing concern in treating periprosthetic joint infection (PJI).
- Linezolid offers high oral bioavailability and low resistance rates, but its efficacy in PJI treatment is variable.
- Limited studies report consistent surgical treatment protocols for PJI using linezolid.
Purpose of the Study:
- To evaluate the efficacy of two-stage revision arthroplasty combined with systemic oral linezolid for resistant gram-positive PJI.
- To determine the mid-term infection control rate and identify factors influencing outcomes.
Main Methods:
- Retrospective analysis of 111 patients undergoing two-stage revision for PJI between 2008 and 2017.
- Patients received 14 days of intravenous tailored antibiotics followed by 28 days of oral linezolid for resistant gram-positive PJI.
- Median follow-up was 43 months, with a focus on reinfection rates and survival.
Main Results:
- The 5-year infection-free survival probability was 77% (95% CI 69-85).
- 22% of patients required re-operation for subsequent infection, with 5% having the same organism.
- Obesity and infection by organisms other than coagulase-negative staphylococci were associated with worse reinfection-free survival.
Conclusions:
- Two-stage revision arthroplasty with oral linezolid provides 77% infection control at the mid-term for resistant gram-positive PJI.
- This treatment strategy is a viable option for managing complex PJI cases.
- Further research may explore optimizing linezolid use and managing risk factors like obesity.
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