Chronic Suppression of Periprosthetic Joint Infections with Oral Antibiotics Increases Infection-Free Survivorship
Background The clinical benefit of chronic suppression with oral antibiotics as a salvage treatment for periprosthetic joint infection is unclear. The purpose of this study was to compare infection-free prosthetic survival rates between patients who received chronic oral antibiotics and those who di...
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| Veröffentlicht in: | Journal of bone and joint surgery. American volume 2015-08, Vol.97 (15), p.1220-1232 |
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| creator | Siqueira, Marcelo B.P., MD Saleh, Anas, MD Klika, Alison K., MS Higuera, Carlos A., MD Barsoum, Wael K., MD O’Rourke, Colin, MS Schmitt, Steven, MD |
| description | Background The clinical benefit of chronic suppression with oral antibiotics as a salvage treatment for periprosthetic joint infection is unclear. The purpose of this study was to compare infection-free prosthetic survival rates between patients who received chronic oral antibiotics and those who did not following irrigation and debridement with polyethylene exchange or two-stage revision for periprosthetic joint infection. Methods We reviewed the records on all irrigation and debridement procedures with polyethylene exchange and two-stage revisions performed at our institution from 1996 to 2010 for hip or knee periprosthetic joint infection. Of 625 patients treated with a total of 655 eligible revisions, ninety-two received chronic oral antibiotics for a minimum of six months and were eligible for inclusion in our study. These patients were compared with a matched cohort (ratio of 1:3) who did not receive chronic oral antibiotics. Results The five-year infection-free prosthetic survival rate was 68.5% (95% confidence interval [CI] = 59.2% to 79.3%) for the antibiotic-suppression group and 41.1% (95% CI = 34.9% to 48.5%) for the non-suppression group (hazard ratio [HR] = 0.63, p = 0.008). Stratification by the type of surgery and the infecting organism showed a higher five-year survival rate for the patients in the suppression group who underwent irrigation and debridement with polyethylene exchange (64.7%) compared with those in the non-suppression group who underwent irrigation and debridement with polyethylene exchange (30.4%, p < 0.0001) and a higher five-year survival rate for the patients in the suppression group who had a Staphylococcus aureus infection (57.4%) compared with those in the non-suppression group who had a Staphylococcus aureus infection (40.1%, p = 0.047). Conclusions Chronic suppression with oral antibiotics increased the infection-free prosthetic survival rate following surgical treatment for periprosthetic joint infection. Patients who underwent irrigation and debridement with polyethylene exchange and those who had a Staphylococcus aureus infection had the greatest benefit. Level of Evidence Therapeutic Level III . See the Instructions for Authors for a complete description of levels of evidence. |
| doi_str_mv | 10.2106/JBJS.N.00999 |
| format | Article |
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The purpose of this study was to compare infection-free prosthetic survival rates between patients who received chronic oral antibiotics and those who did not following irrigation and debridement with polyethylene exchange or two-stage revision for periprosthetic joint infection. Methods We reviewed the records on all irrigation and debridement procedures with polyethylene exchange and two-stage revisions performed at our institution from 1996 to 2010 for hip or knee periprosthetic joint infection. Of 625 patients treated with a total of 655 eligible revisions, ninety-two received chronic oral antibiotics for a minimum of six months and were eligible for inclusion in our study. These patients were compared with a matched cohort (ratio of 1:3) who did not receive chronic oral antibiotics. Results The five-year infection-free prosthetic survival rate was 68.5% (95% confidence interval [CI] = 59.2% to 79.3%) for the antibiotic-suppression group and 41.1% (95% CI = 34.9% to 48.5%) for the non-suppression group (hazard ratio [HR] = 0.63, p = 0.008). Stratification by the type of surgery and the infecting organism showed a higher five-year survival rate for the patients in the suppression group who underwent irrigation and debridement with polyethylene exchange (64.7%) compared with those in the non-suppression group who underwent irrigation and debridement with polyethylene exchange (30.4%, p < 0.0001) and a higher five-year survival rate for the patients in the suppression group who had a Staphylococcus aureus infection (57.4%) compared with those in the non-suppression group who had a Staphylococcus aureus infection (40.1%, p = 0.047). Conclusions Chronic suppression with oral antibiotics increased the infection-free prosthetic survival rate following surgical treatment for periprosthetic joint infection. Patients who underwent irrigation and debridement with polyethylene exchange and those who had a Staphylococcus aureus infection had the greatest benefit. Level of Evidence Therapeutic Level III . See the Instructions for Authors for a complete description of levels of evidence.</description><identifier>ISSN: 0021-9355</identifier><identifier>EISSN: 1535-1386</identifier><identifier>DOI: 10.2106/JBJS.N.00999</identifier><identifier>PMID: 26246256</identifier><language>eng</language><publisher>United States: Copyright by The Journal of Bone and Joint Surgery, Incorporated</publisher><subject>Administration, Oral ; Aged ; Anti-Bacterial Agents - administration & dosage ; Arthroplasty, Replacement, Hip - adverse effects ; Arthroplasty, Replacement, Hip - methods ; Arthroplasty, Replacement, Knee - adverse effects ; Arthroplasty, Replacement, Knee - methods ; Case-Control Studies ; Confidence Intervals ; Databases, Factual ; Debridement - methods ; Disease-Free Survival ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Hip Prosthesis - adverse effects ; Humans ; Kaplan-Meier Estimate ; Knee Prosthesis - adverse effects ; Long-Term Care ; Male ; Middle Aged ; Multivariate Analysis ; Orthopedics ; Proportional Hazards Models ; Prosthesis Failure ; Prosthesis-Related Infections - drug therapy ; Prosthesis-Related Infections - epidemiology ; Prosthesis-Related Infections - microbiology ; Retrospective Studies ; Risk Assessment ; Staphylococcal Infections - drug therapy ; Staphylococcal Infections - etiology ; Staphylococcus aureus ; Treatment Outcome</subject><ispartof>Journal of bone and joint surgery. American volume, 2015-08, Vol.97 (15), p.1220-1232</ispartof><rights>The Journal of Bone and Joint Surgery, Inc.</rights><rights>Copyright 2015 by The Journal of Bone and Joint Surgery, Incorporated</rights><rights>Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4672-be675e1b19c20a6d5f0b82794e6784b2419f631bbbaae8871cb2cddeb3f21ef73</citedby><cites>FETCH-LOGICAL-c4672-be675e1b19c20a6d5f0b82794e6784b2419f631bbbaae8871cb2cddeb3f21ef73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26246256$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Siqueira, Marcelo B.P., MD</creatorcontrib><creatorcontrib>Saleh, Anas, MD</creatorcontrib><creatorcontrib>Klika, Alison K., MS</creatorcontrib><creatorcontrib>Higuera, Carlos A., MD</creatorcontrib><creatorcontrib>Barsoum, Wael K., MD</creatorcontrib><creatorcontrib>O’Rourke, Colin, MS</creatorcontrib><creatorcontrib>Schmitt, Steven, MD</creatorcontrib><title>Chronic Suppression of Periprosthetic Joint Infections with Oral Antibiotics Increases Infection-Free Survivorship</title><title>Journal of bone and joint surgery. American volume</title><addtitle>J Bone Joint Surg Am</addtitle><description>Background The clinical benefit of chronic suppression with oral antibiotics as a salvage treatment for periprosthetic joint infection is unclear. The purpose of this study was to compare infection-free prosthetic survival rates between patients who received chronic oral antibiotics and those who did not following irrigation and debridement with polyethylene exchange or two-stage revision for periprosthetic joint infection. Methods We reviewed the records on all irrigation and debridement procedures with polyethylene exchange and two-stage revisions performed at our institution from 1996 to 2010 for hip or knee periprosthetic joint infection. Of 625 patients treated with a total of 655 eligible revisions, ninety-two received chronic oral antibiotics for a minimum of six months and were eligible for inclusion in our study. These patients were compared with a matched cohort (ratio of 1:3) who did not receive chronic oral antibiotics. Results The five-year infection-free prosthetic survival rate was 68.5% (95% confidence interval [CI] = 59.2% to 79.3%) for the antibiotic-suppression group and 41.1% (95% CI = 34.9% to 48.5%) for the non-suppression group (hazard ratio [HR] = 0.63, p = 0.008). Stratification by the type of surgery and the infecting organism showed a higher five-year survival rate for the patients in the suppression group who underwent irrigation and debridement with polyethylene exchange (64.7%) compared with those in the non-suppression group who underwent irrigation and debridement with polyethylene exchange (30.4%, p < 0.0001) and a higher five-year survival rate for the patients in the suppression group who had a Staphylococcus aureus infection (57.4%) compared with those in the non-suppression group who had a Staphylococcus aureus infection (40.1%, p = 0.047). Conclusions Chronic suppression with oral antibiotics increased the infection-free prosthetic survival rate following surgical treatment for periprosthetic joint infection. Patients who underwent irrigation and debridement with polyethylene exchange and those who had a Staphylococcus aureus infection had the greatest benefit. Level of Evidence Therapeutic Level III . See the Instructions for Authors for a complete description of levels of evidence.</description><subject>Administration, Oral</subject><subject>Aged</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Arthroplasty, Replacement, Hip - adverse effects</subject><subject>Arthroplasty, Replacement, Hip - methods</subject><subject>Arthroplasty, Replacement, Knee - adverse effects</subject><subject>Arthroplasty, Replacement, Knee - methods</subject><subject>Case-Control Studies</subject><subject>Confidence Intervals</subject><subject>Databases, Factual</subject><subject>Debridement - methods</subject><subject>Disease-Free Survival</subject><subject>Drug Administration Schedule</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hip Prosthesis - adverse effects</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Knee Prosthesis - adverse effects</subject><subject>Long-Term Care</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Orthopedics</subject><subject>Proportional Hazards Models</subject><subject>Prosthesis Failure</subject><subject>Prosthesis-Related Infections - drug therapy</subject><subject>Prosthesis-Related Infections - epidemiology</subject><subject>Prosthesis-Related Infections - microbiology</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Staphylococcal Infections - drug therapy</subject><subject>Staphylococcal Infections - etiology</subject><subject>Staphylococcus aureus</subject><subject>Treatment Outcome</subject><issn>0021-9355</issn><issn>1535-1386</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkkFv1DAQhS0EokvhxhnlyIEsYyd24gtSu6LQVdUiLZwtOztR3GbjxU521X_PhC1w5GRr_M2T_N5j7C2HpeCgPq4v15vl7RJAa_2MLbgsZM6LWj1nCwDBc11IecZepXQPAGUJ1Ut2JpQolZBqweKqi2HwTbaZ9vuIKfkwZKHNvmH0-xjS2OFIr-vghzG7HlpsRiJSdvRjl91F22cXw-idD0QlApqINmH6h-ZXEZHU48EfQkyd379mL1rbJ3zzdJ6zH1efv6--5jd3X65XFzd5U6pK5A5VJZE7rhsBVm1lC64WlS5pXpdOlFy3quDOOWuxriveONFst-iKVnBsq-KcvT_p0j9-TphGs_Opwb63A4YpGV5zrkHXXP8frUAoqaqyIPTDCW3InRSxNfvodzY-Gg5mDsTMgZhb8zsQwt89KU9uh9u_8J8ECChPwDH0I8b00E9HjKZD248diVBmShS5AC6hBgn5PBK09um0huTgwdNG03vK0fYP-IjpPkxxIHMNN0kYMJu5CnMTqB50E7L4BXwkrGw</recordid><startdate>20150805</startdate><enddate>20150805</enddate><creator>Siqueira, Marcelo B.P., MD</creator><creator>Saleh, Anas, MD</creator><creator>Klika, Alison K., MS</creator><creator>Higuera, Carlos A., MD</creator><creator>Barsoum, Wael K., MD</creator><creator>O’Rourke, Colin, MS</creator><creator>Schmitt, Steven, MD</creator><general>Copyright by The Journal of Bone and Joint Surgery, Incorporated</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QL</scope><scope>7TS</scope><scope>C1K</scope></search><sort><creationdate>20150805</creationdate><title>Chronic Suppression of Periprosthetic Joint Infections with Oral Antibiotics Increases Infection-Free Survivorship</title><author>Siqueira, Marcelo B.P., MD ; Saleh, Anas, MD ; Klika, Alison K., MS ; Higuera, Carlos A., MD ; Barsoum, Wael K., MD ; O’Rourke, Colin, MS ; Schmitt, Steven, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4672-be675e1b19c20a6d5f0b82794e6784b2419f631bbbaae8871cb2cddeb3f21ef73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Administration, Oral</topic><topic>Aged</topic><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Arthroplasty, Replacement, Hip - adverse effects</topic><topic>Arthroplasty, Replacement, Hip - methods</topic><topic>Arthroplasty, Replacement, Knee - adverse effects</topic><topic>Arthroplasty, Replacement, Knee - methods</topic><topic>Case-Control Studies</topic><topic>Confidence Intervals</topic><topic>Databases, Factual</topic><topic>Debridement - methods</topic><topic>Disease-Free Survival</topic><topic>Drug Administration Schedule</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hip Prosthesis - adverse effects</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Knee Prosthesis - adverse effects</topic><topic>Long-Term Care</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Orthopedics</topic><topic>Proportional Hazards Models</topic><topic>Prosthesis Failure</topic><topic>Prosthesis-Related Infections - drug therapy</topic><topic>Prosthesis-Related Infections - epidemiology</topic><topic>Prosthesis-Related Infections - microbiology</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Staphylococcal Infections - drug therapy</topic><topic>Staphylococcal Infections - etiology</topic><topic>Staphylococcus aureus</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Siqueira, Marcelo B.P., MD</creatorcontrib><creatorcontrib>Saleh, Anas, MD</creatorcontrib><creatorcontrib>Klika, Alison K., MS</creatorcontrib><creatorcontrib>Higuera, Carlos A., MD</creatorcontrib><creatorcontrib>Barsoum, Wael K., MD</creatorcontrib><creatorcontrib>O’Rourke, Colin, MS</creatorcontrib><creatorcontrib>Schmitt, Steven, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Physical Education Index</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Journal of bone and joint surgery. American volume</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Siqueira, Marcelo B.P., MD</au><au>Saleh, Anas, MD</au><au>Klika, Alison K., MS</au><au>Higuera, Carlos A., MD</au><au>Barsoum, Wael K., MD</au><au>O’Rourke, Colin, MS</au><au>Schmitt, Steven, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chronic Suppression of Periprosthetic Joint Infections with Oral Antibiotics Increases Infection-Free Survivorship</atitle><jtitle>Journal of bone and joint surgery. American volume</jtitle><addtitle>J Bone Joint Surg Am</addtitle><date>2015-08-05</date><risdate>2015</risdate><volume>97</volume><issue>15</issue><spage>1220</spage><epage>1232</epage><pages>1220-1232</pages><issn>0021-9355</issn><eissn>1535-1386</eissn><abstract>Background The clinical benefit of chronic suppression with oral antibiotics as a salvage treatment for periprosthetic joint infection is unclear. The purpose of this study was to compare infection-free prosthetic survival rates between patients who received chronic oral antibiotics and those who did not following irrigation and debridement with polyethylene exchange or two-stage revision for periprosthetic joint infection. Methods We reviewed the records on all irrigation and debridement procedures with polyethylene exchange and two-stage revisions performed at our institution from 1996 to 2010 for hip or knee periprosthetic joint infection. Of 625 patients treated with a total of 655 eligible revisions, ninety-two received chronic oral antibiotics for a minimum of six months and were eligible for inclusion in our study. These patients were compared with a matched cohort (ratio of 1:3) who did not receive chronic oral antibiotics. Results The five-year infection-free prosthetic survival rate was 68.5% (95% confidence interval [CI] = 59.2% to 79.3%) for the antibiotic-suppression group and 41.1% (95% CI = 34.9% to 48.5%) for the non-suppression group (hazard ratio [HR] = 0.63, p = 0.008). Stratification by the type of surgery and the infecting organism showed a higher five-year survival rate for the patients in the suppression group who underwent irrigation and debridement with polyethylene exchange (64.7%) compared with those in the non-suppression group who underwent irrigation and debridement with polyethylene exchange (30.4%, p < 0.0001) and a higher five-year survival rate for the patients in the suppression group who had a Staphylococcus aureus infection (57.4%) compared with those in the non-suppression group who had a Staphylococcus aureus infection (40.1%, p = 0.047). Conclusions Chronic suppression with oral antibiotics increased the infection-free prosthetic survival rate following surgical treatment for periprosthetic joint infection. Patients who underwent irrigation and debridement with polyethylene exchange and those who had a Staphylococcus aureus infection had the greatest benefit. Level of Evidence Therapeutic Level III . See the Instructions for Authors for a complete description of levels of evidence.</abstract><cop>United States</cop><pub>Copyright by The Journal of Bone and Joint Surgery, Incorporated</pub><pmid>26246256</pmid><doi>10.2106/JBJS.N.00999</doi><tpages>13</tpages></addata></record> |
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| subjects | Administration, Oral Aged Anti-Bacterial Agents - administration & dosage Arthroplasty, Replacement, Hip - adverse effects Arthroplasty, Replacement, Hip - methods Arthroplasty, Replacement, Knee - adverse effects Arthroplasty, Replacement, Knee - methods Case-Control Studies Confidence Intervals Databases, Factual Debridement - methods Disease-Free Survival Drug Administration Schedule Female Follow-Up Studies Hip Prosthesis - adverse effects Humans Kaplan-Meier Estimate Knee Prosthesis - adverse effects Long-Term Care Male Middle Aged Multivariate Analysis Orthopedics Proportional Hazards Models Prosthesis Failure Prosthesis-Related Infections - drug therapy Prosthesis-Related Infections - epidemiology Prosthesis-Related Infections - microbiology Retrospective Studies Risk Assessment Staphylococcal Infections - drug therapy Staphylococcal Infections - etiology Staphylococcus aureus Treatment Outcome |
| title | Chronic Suppression of Periprosthetic Joint Infections with Oral Antibiotics Increases Infection-Free Survivorship |
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