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Adverse Events Associated with Prolonged Antibiotic Therapy for Periprosthetic Joint Infections-A Prospective Study
Pia Reinecke1, Paula Morovic1, Marcel Niemann1
1Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Augustenburger Platz 1, 13353 Berlin, Germany.
Abstract:
Periprosthetic Joint Infection (PJI) is a significant contributor to patient morbidity and mortality, and it can be addressed through a range of surgical interventions coupled with antibiotic therapies. Following surgical intervention(s), prolonged administration of oral antibiotics is recommended to cure PJI. There is a lack of reports on the adverse events (AEs) associated with oral antibiotics, particularly rifampin. This investigation sought to elucidate the occurrence of antibiotic-related AEs after an initial regimen of intravenous antibiotic administration, supplemented by an extended course of oral antibiotics. A prospective study of patients diagnosed with PJI of the hip, knee, or shoulder who underwent single-stage exchange arthroplasty (SSE) (10%), two-stage exchange arthroplasty (TSE) (81%), or debridement, antibiotics, and implant retention (DAIR) (6%) was performed. The primary outcome of interest was the detection of AEs, the secondary outcome the detection of a correlation between rifampin use and the incidence of AEs, and the tertiary outcome was whether oral antibiotic treatment needed to be adjusted or discontinued due to AEs. In addition, subjective tolerability was monitored throughout the study. A total of 336 events were identified for 73 out of 80 patients. The most frequently used antibiotics were rifampin and co-trimoxazole. Most AEs occurred in the gastrointestinal tract (46%). The most frequent AEs were nausea, inappetence, diarrhea, and skin rash. In 6% of cases, the AEs led to antibiotic discontinuation, and in 29% of cases, a dose adjustment of the oral therapy occurred, mainly with amoxicillin or co-trimoxazole. The majority of patients (55%) rated the subjective tolerability as good. In conclusion, AEs during antibiotic treatment for PJI are common. They mainly affect the gastrointestinal tract. Rifampin use might be a reason for the higher incidence of AEs compared to non-rifampin antibiotic treatment.
Insights
Adverse events (AEs) from oral antibiotics are common in treating Periprosthetic Joint Infection (PJI), frequently causing gastrointestinal issues. Rifampin may increase AE incidence, often necessitating treatment adjustments.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Pharmacology
Background:
- Periprosthetic Joint Infection (PJI) is a serious complication following joint replacement surgery.
- Prolonged oral antibiotic therapy is standard for PJI treatment, but associated adverse events (AEs) are underreported.
- Rifampin is frequently used but its specific AE profile in PJI requires further investigation.
Purpose of the Study:
- To investigate the incidence and nature of antibiotic-related AEs in patients with PJI.
- To assess the correlation between rifampin use and AEs.
- To determine the impact of AEs on oral antibiotic regimen adjustments or discontinuation.
Main Methods:
- Prospective study of 80 patients with PJI undergoing various surgical interventions (SSE, TSE, DAIR).
- Monitoring of antibiotic-related AEs, focusing on gastrointestinal and dermatological events.
- Evaluation of treatment modifications and subjective tolerability.
Main Results:
- 336 AEs were reported in 73 patients; gastrointestinal issues (46%) were most common (nausea, diarrhea).
- Rifampin and co-trimoxazole were frequently used; rifampin use was associated with a higher AE incidence.
- AEs led to discontinuation in 6% and dose adjustment in 29% of cases, primarily with amoxicillin or co-trimoxazole.
Conclusions:
- Antibiotic treatment for PJI commonly causes AEs, predominantly gastrointestinal.
- Rifampin may contribute to a higher incidence of AEs compared to other oral antibiotics.
- Careful monitoring and potential regimen adjustments are crucial for managing PJI patients on oral antibiotics.
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