The Impact of Antibiotic Therapy Options and Multidisciplinary Approach in Prosthetic Joint Infections

Area of Science:

• Orthopedics
• Infectious Diseases
• Pharmacology

Background:

• Periprosthetic joint infection (PJI) is a major challenge in arthroplasty.
• Optimal antibiotic strategies and the role of multidisciplinary teams (MDT) in PJI management require further definition.

Purpose of the Study:

• To evaluate the impact of different antibiotic regimens and treatment team structures on PJI outcomes.
• To identify predictors of success in PJI management.

Main Methods:

• Retrospective analysis of 86 PJI surgical procedures (2017-2023).
• Data collected on clinical factors, microbiology, surgical strategy (DAIR, one-stage, two-stage), and antibiotic regimens.
• Outcomes compared across antibiotic classes and treatment teams (orthopaedics alone, orthopaedics with MDT, dedicated MDT).

Main Results:

• Rifampicin-based regimens showed higher cure rates than non-anti-biofilm therapies.
• Flucloxacillin plus rifampicin demonstrated comparable outcomes to rifampicin-fluoroquinolone combinations.
• MDT involvement was the strongest predictor of success, particularly in DAIR procedures (100% cure with MDT vs. 48% with orthopaedics alone, p=0.025).

Conclusions:

• Rifampicin-based therapy and flucloxacillin are effective for staphylococcal PJI.
• Multidisciplinary team management, especially for DAIR procedures, significantly improves PJI treatment outcomes.
• Structured MDT care pathways combined with optimized antibiotic strategies are crucial for successful PJI management.