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Targeted antimicrobial regimens for Gram-negative prosthetic joint infections: a prospective multicenter study
Jaap L J Hanssen1, Robert J P van der Wal2, Rachid Mahdad3
1Leiden University Center for Infectious Diseases (LU-CID), Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands.
Antimicrobial Agents and Chemotherapy
|November 13, 2024
Summary
Cotrimoxazole shows promise as an effective treatment for Gram-negative prosthetic joint infections (GN-PJI), offering an alternative to fluoroquinolones (FQs). Further research is needed to confirm its efficacy in GN-PJI management.
Area of Science:
- Orthopedics
- Infectious Diseases
- Pharmacology
Background:
- Gram-negative prosthetic joint infection (GN-PJI) is a serious complication.
- Fluoroquinolones (FQs) are the primary treatment but face rising resistance and side effects.
- Alternative antimicrobial strategies are crucial for effective GN-PJI management.
Purpose of the Study:
- To compare targeted antimicrobial strategies for GN-PJI.
- To evaluate treatments including oral fluoroquinolones (FQs), cotrimoxazole, and β-lactams.
- To review oral treatment options for GN-PJI.
Main Methods:
- Prospective, multicenter, registry-based study (2015-2020).
- Included patients with GN-PJI managed by debridement, antibiotics, and implant retention (DAIR) or one-stage revision (1SR).
- Survival analysis using Kaplan-Meier and Cox models.
Main Results:
- Seventy-four patients received FQ (64%), cotrimoxazole (18%), or β-lactams (18%).
- Failure-free survival did not significantly differ between FQ (72%) and cotrimoxazole (92%) groups.
- Cotrimoxazole demonstrated comparable outcomes to FQs in this cohort.
Conclusions:
- Cotrimoxazole is a potential effective targeted therapy for GN-PJI.
- This study suggests cotrimoxazole as a viable alternative to FQs.
- A randomized controlled trial is recommended to validate these findings.
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