Prolonged suppressive antibiotic therapy for prosthetic joint infection in the elderly: a national multicentre cohort study
During prosthetic joint infection (PJI), optimal surgical management with exchange of the device is sometimes impossible, especially in the elderly population. Thus, prolonged suppressive antibiotic therapy (PSAT) is the only option to prevent acute sepsis, but little is known about this strategy. W...
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| Veröffentlicht in: | European journal of clinical microbiology & infectious diseases 2017-09, Vol.36 (9), p.1577-1585 |
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| creator | Prendki, V. Ferry, T. Sergent, P. Oziol, E. Forestier, E. Fraisse, T. Tounes, S. Ansart, S. Gaillat, J. Bayle, S. Ruyer, O. Borlot, F. Le Falher, G. Simorre, B. Dauchy, F.-A. Greffe, S. Bauer, T. Bell, E. N. Martha, B. Martinot, M. Froidure, M. Buisson, M. Waldner, A. Lemaire, X. Bosseray, A. Maillet, M. Charvet, V. Barrelet, A. Wyplosz, B. Noaillon, M. Denes, E. Beretti, E. Berlioz-Thibal, M. Meyssonnier, V. Fourniols, E. Tliba, L. Eden, A. Jean, M. Arvieux, C. Guignery-Kadri, K. Ronde-Oustau, C. Hansmann, Y. Belkacem, A. Bouchand, F. Gavazzi, G. Herrmann, F. Stirnemann, J. Dinh, A. |
| description | During prosthetic joint infection (PJI), optimal surgical management with exchange of the device is sometimes impossible, especially in the elderly population. Thus, prolonged suppressive antibiotic therapy (PSAT) is the only option to prevent acute sepsis, but little is known about this strategy. We aimed to describe the characteristics, outcome and tolerance of PSAT in elderly patients with PJI. We performed a national cross-sectional cohort study of patients >75 years old and treated with PSAT for PJI. We evaluated the occurrence of events, which were defined as: (i) local or systemic progression of the infection (failure), (ii) death and (iii) discontinuation or switch of PSAT. A total of 136 patients were included, with a median age of 83 years [interquartile range (IQR) 81–88]. The predominant pathogen involved was
Staphylococcus
(62.1%) (
Staphylococcus aureus
in 41.7%). A single antimicrobial drug was prescribed in 96 cases (70.6%). There were 46 (33.8%) patients with an event: 25 (18%) with an adverse drug reaction leading to definitive discontinuation or switch of PSAT, 8 (5.9%) with progression of sepsis and 13 died (9.6%). Among patients under follow-up, the survival rate without an event at 2 years was 61% [95% confidence interval (CI): 51;74]. In the multivariate Cox analysis, patients with higher World Health Organization (WHO) score had an increased risk of an event [hazard ratio (HR) = 1.5,
p
= 0.014], whereas patients treated with beta-lactams are associated with less risk of events occurring (HR = 0.5,
p
= 0.048). In our cohort, PSAT could be an effective and safe option for PJI in the elderly. |
| doi_str_mv | 10.1007/s10096-017-2971-2 |
| format | Article |
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Staphylococcus
(62.1%) (
Staphylococcus aureus
in 41.7%). A single antimicrobial drug was prescribed in 96 cases (70.6%). There were 46 (33.8%) patients with an event: 25 (18%) with an adverse drug reaction leading to definitive discontinuation or switch of PSAT, 8 (5.9%) with progression of sepsis and 13 died (9.6%). Among patients under follow-up, the survival rate without an event at 2 years was 61% [95% confidence interval (CI): 51;74]. In the multivariate Cox analysis, patients with higher World Health Organization (WHO) score had an increased risk of an event [hazard ratio (HR) = 1.5,
p
= 0.014], whereas patients treated with beta-lactams are associated with less risk of events occurring (HR = 0.5,
p
= 0.048). In our cohort, PSAT could be an effective and safe option for PJI in the elderly.</description><identifier>ISSN: 0934-9723</identifier><identifier>EISSN: 1435-4373</identifier><identifier>DOI: 10.1007/s10096-017-2971-2</identifier><identifier>PMID: 28378243</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Age Factors ; Aged, 80 and over ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Antimicrobial agents ; Arthritis, Infectious - drug therapy ; Arthritis, Infectious - epidemiology ; Arthritis, Infectious - microbiology ; Arthritis, Infectious - mortality ; Bacteriology ; Biomedical and Life Sciences ; Biomedicine ; Cohort analysis ; Confidence intervals ; Female ; Geriatrics ; Health risk assessment ; Humans ; Immunology ; Infections ; Internal Medicine ; Joint diseases ; Life Sciences ; Male ; Medical Microbiology ; Microbiology and Parasitology ; Older people ; Original Article ; Pathogens ; Patients ; Prostheses ; Prosthesis-Related Infections - drug therapy ; Prosthesis-Related Infections - epidemiology ; Prosthesis-Related Infections - microbiology ; Prosthesis-Related Infections - mortality ; Sepsis ; Survival ; Therapy ; Time Factors ; Treatment Outcome ; Virology</subject><ispartof>European journal of clinical microbiology & infectious diseases, 2017-09, Vol.36 (9), p.1577-1585</ispartof><rights>Springer-Verlag Berlin Heidelberg 2017</rights><rights>European Journal of Clinical Microbiology & Infectious Diseases is a copyright of Springer, 2017.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c454t-4daa370e1eeed95578b8a1ad8f810433fceb4998335b1b5287abf9f8ad55aa643</citedby><cites>FETCH-LOGICAL-c454t-4daa370e1eeed95578b8a1ad8f810433fceb4998335b1b5287abf9f8ad55aa643</cites><orcidid>0000-0002-5843-4819 ; 0000-0002-2388-1838 ; 0000-0003-3082-7001</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10096-017-2971-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10096-017-2971-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,315,782,786,887,27933,27934,41497,42566,51328</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28378243$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-01917837$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Prendki, V.</creatorcontrib><creatorcontrib>Ferry, T.</creatorcontrib><creatorcontrib>Sergent, P.</creatorcontrib><creatorcontrib>Oziol, E.</creatorcontrib><creatorcontrib>Forestier, E.</creatorcontrib><creatorcontrib>Fraisse, T.</creatorcontrib><creatorcontrib>Tounes, S.</creatorcontrib><creatorcontrib>Ansart, S.</creatorcontrib><creatorcontrib>Gaillat, J.</creatorcontrib><creatorcontrib>Bayle, S.</creatorcontrib><creatorcontrib>Ruyer, O.</creatorcontrib><creatorcontrib>Borlot, F.</creatorcontrib><creatorcontrib>Le Falher, G.</creatorcontrib><creatorcontrib>Simorre, B.</creatorcontrib><creatorcontrib>Dauchy, F.-A.</creatorcontrib><creatorcontrib>Greffe, S.</creatorcontrib><creatorcontrib>Bauer, T.</creatorcontrib><creatorcontrib>Bell, E. N.</creatorcontrib><creatorcontrib>Martha, B.</creatorcontrib><creatorcontrib>Martinot, M.</creatorcontrib><creatorcontrib>Froidure, M.</creatorcontrib><creatorcontrib>Buisson, M.</creatorcontrib><creatorcontrib>Waldner, A.</creatorcontrib><creatorcontrib>Lemaire, X.</creatorcontrib><creatorcontrib>Bosseray, A.</creatorcontrib><creatorcontrib>Maillet, M.</creatorcontrib><creatorcontrib>Charvet, V.</creatorcontrib><creatorcontrib>Barrelet, A.</creatorcontrib><creatorcontrib>Wyplosz, B.</creatorcontrib><creatorcontrib>Noaillon, M.</creatorcontrib><creatorcontrib>Denes, E.</creatorcontrib><creatorcontrib>Beretti, E.</creatorcontrib><creatorcontrib>Berlioz-Thibal, M.</creatorcontrib><creatorcontrib>Meyssonnier, V.</creatorcontrib><creatorcontrib>Fourniols, E.</creatorcontrib><creatorcontrib>Tliba, L.</creatorcontrib><creatorcontrib>Eden, A.</creatorcontrib><creatorcontrib>Jean, M.</creatorcontrib><creatorcontrib>Arvieux, C.</creatorcontrib><creatorcontrib>Guignery-Kadri, K.</creatorcontrib><creatorcontrib>Ronde-Oustau, C.</creatorcontrib><creatorcontrib>Hansmann, Y.</creatorcontrib><creatorcontrib>Belkacem, A.</creatorcontrib><creatorcontrib>Bouchand, F.</creatorcontrib><creatorcontrib>Gavazzi, G.</creatorcontrib><creatorcontrib>Herrmann, F.</creatorcontrib><creatorcontrib>Stirnemann, J.</creatorcontrib><creatorcontrib>Dinh, A.</creatorcontrib><title>Prolonged suppressive antibiotic therapy for prosthetic joint infection in the elderly: a national multicentre cohort study</title><title>European journal of clinical microbiology & infectious diseases</title><addtitle>Eur J Clin Microbiol Infect Dis</addtitle><addtitle>Eur J Clin Microbiol Infect Dis</addtitle><description>During prosthetic joint infection (PJI), optimal surgical management with exchange of the device is sometimes impossible, especially in the elderly population. Thus, prolonged suppressive antibiotic therapy (PSAT) is the only option to prevent acute sepsis, but little is known about this strategy. We aimed to describe the characteristics, outcome and tolerance of PSAT in elderly patients with PJI. We performed a national cross-sectional cohort study of patients >75 years old and treated with PSAT for PJI. We evaluated the occurrence of events, which were defined as: (i) local or systemic progression of the infection (failure), (ii) death and (iii) discontinuation or switch of PSAT. A total of 136 patients were included, with a median age of 83 years [interquartile range (IQR) 81–88]. The predominant pathogen involved was
Staphylococcus
(62.1%) (
Staphylococcus aureus
in 41.7%). A single antimicrobial drug was prescribed in 96 cases (70.6%). There were 46 (33.8%) patients with an event: 25 (18%) with an adverse drug reaction leading to definitive discontinuation or switch of PSAT, 8 (5.9%) with progression of sepsis and 13 died (9.6%). Among patients under follow-up, the survival rate without an event at 2 years was 61% [95% confidence interval (CI): 51;74]. In the multivariate Cox analysis, patients with higher World Health Organization (WHO) score had an increased risk of an event [hazard ratio (HR) = 1.5,
p
= 0.014], whereas patients treated with beta-lactams are associated with less risk of events occurring (HR = 0.5,
p
= 0.048). In our cohort, PSAT could be an effective and safe option for PJI in the elderly.</description><subject>Age Factors</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Antimicrobial agents</subject><subject>Arthritis, Infectious - drug therapy</subject><subject>Arthritis, Infectious - epidemiology</subject><subject>Arthritis, Infectious - microbiology</subject><subject>Arthritis, Infectious - mortality</subject><subject>Bacteriology</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Cohort analysis</subject><subject>Confidence intervals</subject><subject>Female</subject><subject>Geriatrics</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Immunology</subject><subject>Infections</subject><subject>Internal Medicine</subject><subject>Joint diseases</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Medical Microbiology</subject><subject>Microbiology and Parasitology</subject><subject>Older people</subject><subject>Original Article</subject><subject>Pathogens</subject><subject>Patients</subject><subject>Prostheses</subject><subject>Prosthesis-Related Infections - drug therapy</subject><subject>Prosthesis-Related Infections - epidemiology</subject><subject>Prosthesis-Related Infections - microbiology</subject><subject>Prosthesis-Related Infections - mortality</subject><subject>Sepsis</subject><subject>Survival</subject><subject>Therapy</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Virology</subject><issn>0934-9723</issn><issn>1435-4373</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp1kU1v1DAQhi0EotvCD-CCLHGhh4A_a5tbVdEWaSU4wNlykgnrlTcOtlNp1T-Po5SqQurFHzPPOx7Pi9A7Sj5RQtTnXFdz0RCqGmYUbdgLtKGCy0ZwxV-iDTFcNEYxfoJOc96TqtFKvUYnTHOlmeAbdP8jxRDH39DjPE9Tgpz9HWA3Ft_6WHyHyw6Sm454iAlPKeZ6X8L76MeC_ThAV3wc62khMYQeUjh-wQ6Pbkm4gA9zqAoYSwLcxV1MBecy98c36NXgQoa3D_sZ-nX99efVbbP9fvPt6nLbdEKK0ojeOa4IUADojZRKt9pR1-tBUyI4HzpohTGac9nSVjKtXDuYQbteSucuBD9D52vdnQt2Sv7g0tFG5-3t5dYuMUINVXUkd7SyH1e2fvXPDLnYg88dhOBGiHO2VGshFBN6KfvhP3Qf51Q_XCnDlJGMS14pulJdnV1OMDx2QIldXLSri7UJZRcXLaua9w-V5_YA_aPin20VYCuQa6qal548_WzVv-kDqXY</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Prendki, V.</creator><creator>Ferry, T.</creator><creator>Sergent, P.</creator><creator>Oziol, E.</creator><creator>Forestier, E.</creator><creator>Fraisse, T.</creator><creator>Tounes, S.</creator><creator>Ansart, S.</creator><creator>Gaillat, J.</creator><creator>Bayle, S.</creator><creator>Ruyer, O.</creator><creator>Borlot, F.</creator><creator>Le Falher, G.</creator><creator>Simorre, B.</creator><creator>Dauchy, F.-A.</creator><creator>Greffe, S.</creator><creator>Bauer, T.</creator><creator>Bell, E. 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N. ; Martha, B. ; Martinot, M. ; Froidure, M. ; Buisson, M. ; Waldner, A. ; Lemaire, X. ; Bosseray, A. ; Maillet, M. ; Charvet, V. ; Barrelet, A. ; Wyplosz, B. ; Noaillon, M. ; Denes, E. ; Beretti, E. ; Berlioz-Thibal, M. ; Meyssonnier, V. ; Fourniols, E. ; Tliba, L. ; Eden, A. ; Jean, M. ; Arvieux, C. ; Guignery-Kadri, K. ; Ronde-Oustau, C. ; Hansmann, Y. ; Belkacem, A. ; Bouchand, F. ; Gavazzi, G. ; Herrmann, F. ; Stirnemann, J. ; Dinh, A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c454t-4daa370e1eeed95578b8a1ad8f810433fceb4998335b1b5287abf9f8ad55aa643</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Age Factors</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>Antimicrobial agents</topic><topic>Arthritis, Infectious - drug therapy</topic><topic>Arthritis, Infectious - epidemiology</topic><topic>Arthritis, Infectious - microbiology</topic><topic>Arthritis, Infectious - mortality</topic><topic>Bacteriology</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Cohort analysis</topic><topic>Confidence intervals</topic><topic>Female</topic><topic>Geriatrics</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Immunology</topic><topic>Infections</topic><topic>Internal Medicine</topic><topic>Joint diseases</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Medical Microbiology</topic><topic>Microbiology and Parasitology</topic><topic>Older people</topic><topic>Original Article</topic><topic>Pathogens</topic><topic>Patients</topic><topic>Prostheses</topic><topic>Prosthesis-Related Infections - drug therapy</topic><topic>Prosthesis-Related Infections - epidemiology</topic><topic>Prosthesis-Related Infections - microbiology</topic><topic>Prosthesis-Related Infections - mortality</topic><topic>Sepsis</topic><topic>Survival</topic><topic>Therapy</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Virology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Prendki, V.</creatorcontrib><creatorcontrib>Ferry, T.</creatorcontrib><creatorcontrib>Sergent, P.</creatorcontrib><creatorcontrib>Oziol, E.</creatorcontrib><creatorcontrib>Forestier, E.</creatorcontrib><creatorcontrib>Fraisse, T.</creatorcontrib><creatorcontrib>Tounes, S.</creatorcontrib><creatorcontrib>Ansart, S.</creatorcontrib><creatorcontrib>Gaillat, J.</creatorcontrib><creatorcontrib>Bayle, S.</creatorcontrib><creatorcontrib>Ruyer, O.</creatorcontrib><creatorcontrib>Borlot, F.</creatorcontrib><creatorcontrib>Le Falher, G.</creatorcontrib><creatorcontrib>Simorre, B.</creatorcontrib><creatorcontrib>Dauchy, F.-A.</creatorcontrib><creatorcontrib>Greffe, S.</creatorcontrib><creatorcontrib>Bauer, T.</creatorcontrib><creatorcontrib>Bell, E. N.</creatorcontrib><creatorcontrib>Martha, B.</creatorcontrib><creatorcontrib>Martinot, M.</creatorcontrib><creatorcontrib>Froidure, M.</creatorcontrib><creatorcontrib>Buisson, M.</creatorcontrib><creatorcontrib>Waldner, A.</creatorcontrib><creatorcontrib>Lemaire, X.</creatorcontrib><creatorcontrib>Bosseray, A.</creatorcontrib><creatorcontrib>Maillet, M.</creatorcontrib><creatorcontrib>Charvet, V.</creatorcontrib><creatorcontrib>Barrelet, A.</creatorcontrib><creatorcontrib>Wyplosz, B.</creatorcontrib><creatorcontrib>Noaillon, M.</creatorcontrib><creatorcontrib>Denes, E.</creatorcontrib><creatorcontrib>Beretti, E.</creatorcontrib><creatorcontrib>Berlioz-Thibal, M.</creatorcontrib><creatorcontrib>Meyssonnier, V.</creatorcontrib><creatorcontrib>Fourniols, E.</creatorcontrib><creatorcontrib>Tliba, L.</creatorcontrib><creatorcontrib>Eden, A.</creatorcontrib><creatorcontrib>Jean, M.</creatorcontrib><creatorcontrib>Arvieux, C.</creatorcontrib><creatorcontrib>Guignery-Kadri, K.</creatorcontrib><creatorcontrib>Ronde-Oustau, C.</creatorcontrib><creatorcontrib>Hansmann, Y.</creatorcontrib><creatorcontrib>Belkacem, A.</creatorcontrib><creatorcontrib>Bouchand, F.</creatorcontrib><creatorcontrib>Gavazzi, G.</creatorcontrib><creatorcontrib>Herrmann, F.</creatorcontrib><creatorcontrib>Stirnemann, J.</creatorcontrib><creatorcontrib>Dinh, A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Biology Database (Alumni Edition)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>European journal of clinical microbiology & infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Prendki, V.</au><au>Ferry, T.</au><au>Sergent, P.</au><au>Oziol, E.</au><au>Forestier, E.</au><au>Fraisse, T.</au><au>Tounes, S.</au><au>Ansart, S.</au><au>Gaillat, J.</au><au>Bayle, S.</au><au>Ruyer, O.</au><au>Borlot, F.</au><au>Le Falher, G.</au><au>Simorre, B.</au><au>Dauchy, F.-A.</au><au>Greffe, S.</au><au>Bauer, T.</au><au>Bell, E. N.</au><au>Martha, B.</au><au>Martinot, M.</au><au>Froidure, M.</au><au>Buisson, M.</au><au>Waldner, A.</au><au>Lemaire, X.</au><au>Bosseray, A.</au><au>Maillet, M.</au><au>Charvet, V.</au><au>Barrelet, A.</au><au>Wyplosz, B.</au><au>Noaillon, M.</au><au>Denes, E.</au><au>Beretti, E.</au><au>Berlioz-Thibal, M.</au><au>Meyssonnier, V.</au><au>Fourniols, E.</au><au>Tliba, L.</au><au>Eden, A.</au><au>Jean, M.</au><au>Arvieux, C.</au><au>Guignery-Kadri, K.</au><au>Ronde-Oustau, C.</au><au>Hansmann, Y.</au><au>Belkacem, A.</au><au>Bouchand, F.</au><au>Gavazzi, G.</au><au>Herrmann, F.</au><au>Stirnemann, J.</au><au>Dinh, A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prolonged suppressive antibiotic therapy for prosthetic joint infection in the elderly: a national multicentre cohort study</atitle><jtitle>European journal of clinical microbiology & infectious diseases</jtitle><stitle>Eur J Clin Microbiol Infect Dis</stitle><addtitle>Eur J Clin Microbiol Infect Dis</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>36</volume><issue>9</issue><spage>1577</spage><epage>1585</epage><pages>1577-1585</pages><issn>0934-9723</issn><eissn>1435-4373</eissn><abstract>During prosthetic joint infection (PJI), optimal surgical management with exchange of the device is sometimes impossible, especially in the elderly population. Thus, prolonged suppressive antibiotic therapy (PSAT) is the only option to prevent acute sepsis, but little is known about this strategy. We aimed to describe the characteristics, outcome and tolerance of PSAT in elderly patients with PJI. We performed a national cross-sectional cohort study of patients >75 years old and treated with PSAT for PJI. We evaluated the occurrence of events, which were defined as: (i) local or systemic progression of the infection (failure), (ii) death and (iii) discontinuation or switch of PSAT. A total of 136 patients were included, with a median age of 83 years [interquartile range (IQR) 81–88]. The predominant pathogen involved was
Staphylococcus
(62.1%) (
Staphylococcus aureus
in 41.7%). A single antimicrobial drug was prescribed in 96 cases (70.6%). There were 46 (33.8%) patients with an event: 25 (18%) with an adverse drug reaction leading to definitive discontinuation or switch of PSAT, 8 (5.9%) with progression of sepsis and 13 died (9.6%). Among patients under follow-up, the survival rate without an event at 2 years was 61% [95% confidence interval (CI): 51;74]. In the multivariate Cox analysis, patients with higher World Health Organization (WHO) score had an increased risk of an event [hazard ratio (HR) = 1.5,
p
= 0.014], whereas patients treated with beta-lactams are associated with less risk of events occurring (HR = 0.5,
p
= 0.048). In our cohort, PSAT could be an effective and safe option for PJI in the elderly.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>28378243</pmid><doi>10.1007/s10096-017-2971-2</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-5843-4819</orcidid><orcidid>https://orcid.org/0000-0002-2388-1838</orcidid><orcidid>https://orcid.org/0000-0003-3082-7001</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0934-9723 |
| ispartof | European journal of clinical microbiology & infectious diseases, 2017-09, Vol.36 (9), p.1577-1585 |
| issn | 0934-9723 1435-4373 |
| language | eng |
| recordid | cdi_hal_primary_oai_HAL_hal_01917837v1 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Age Factors Aged, 80 and over Anti-Bacterial Agents - therapeutic use Antibiotics Antimicrobial agents Arthritis, Infectious - drug therapy Arthritis, Infectious - epidemiology Arthritis, Infectious - microbiology Arthritis, Infectious - mortality Bacteriology Biomedical and Life Sciences Biomedicine Cohort analysis Confidence intervals Female Geriatrics Health risk assessment Humans Immunology Infections Internal Medicine Joint diseases Life Sciences Male Medical Microbiology Microbiology and Parasitology Older people Original Article Pathogens Patients Prostheses Prosthesis-Related Infections - drug therapy Prosthesis-Related Infections - epidemiology Prosthesis-Related Infections - microbiology Prosthesis-Related Infections - mortality Sepsis Survival Therapy Time Factors Treatment Outcome Virology |
| title | Prolonged suppressive antibiotic therapy for prosthetic joint infection in the elderly: a national multicentre cohort study |
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