Prolonged suppressive antibiotic therapy is successful in the management of prosthetic joint infection

2019 ◽  
Vol 30 (2) ◽  
pp. 313-321 ◽  
Author(s):  
N. A. Sandiford ◽  
J. R. Hutt ◽  
D. O. Kendoff ◽  
P. A. Mitchell ◽  
M. Citak ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Prosthetic Joint ◽  
Suppressive Antibiotic Therapy

scholarly journals Subcutaneous suppressive antibiotic therapy for bone and joint infections: safety and outcome in a cohort of 10 patients

2019 ◽  
Vol 74 (7) ◽  
pp. 2060-2064 ◽  
Author(s):  
Cécile Pouderoux ◽  
Agathe Becker ◽  
Sylvain Goutelle ◽  
Sébastien Lustig ◽  
Claire Triffault-Fillit ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Prosthetic Joint Infection ◽  
Salvage Therapy ◽  
Chronic Osteomyelitis ◽  
Joint Infection ◽  
Intensive Therapy ◽  
Treatment Modalities ◽  
Surgical Removal ◽  
Prosthetic Joint ◽  
Suppressive Antibiotic Therapy

Abstract Background Optimal treatment of prosthetic joint infection and chronic osteomyelitis consists of surgical removal of biofilm-embedded bacteria, followed by a 6–12 week course of antimicrobial therapy. However, when optimal surgery is not feasible, oral prolonged suppressive antibiotic therapy (PSAT) is recommended to prevent prosthesis loosening and/or relapse of infection. Since 2010, we have used infection salvage therapy using off-label subcutaneous (sc) injection of a β-lactam as PSAT for patients in whom oral PSAT is not possible. Methods A single-centre prospective cohort study (2010–18) reporting treatment modalities, efficacy and safety in all patients receiving sc PSAT. NCT03403608. Results The 10 included patients (median age 79 years) had polymicrobial (n = 5) or MDR bacterial (n = 4) prosthetic joint infection (knee, n = 4; hip, n = 3) or chronic osteomyelitis (n = 3). After initial intensive therapy, seven patients received ertapenem, three patients received ceftriaxone and one patient received ceftazidime by sc injection (one patient received 8 days of ceftriaxone before receiving ertapenem). In one patient, sc PSAT failed with recurrent signs of infection under treatment. In three patients, sc PSAT had to be discontinued due to side effects; in only one of these was the sc route implicated (skin necrosis following direct sc injection and not gravity infusion). Median treatment duration was 433 days. In six patients, sc PSAT was successful with favourable outcome at the time of writing. Interestingly, three patients with MDR bacterial carriage at baseline lost this under PSAT during follow-up. Conclusions As salvage therapy, sc PSAT delivered by gravity infusion is a safe and interesting alternative when an optimal surgical strategy is not feasible and no oral treatment is available.

scholarly journals Outcome of patients over 80 years of age on prolonged suppressive antibiotic therapy for at least 6 months for prosthetic joint infection

2014 ◽  
Vol 29 ◽  
pp. 184-189 ◽  
Author(s):  
Virginie Prendki ◽  
Valérie Zeller ◽  
Dorick Passeron ◽  
Nicole Desplaces ◽  
Patrick Mamoudy ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Prosthetic Joint ◽  
Suppressive Antibiotic Therapy

scholarly journals Salvage Procedures for Management of Prosthetic Joint Infection After Hip and Knee Replacements

2016 ◽  
Vol 10 (1) ◽  
pp. 600-614 ◽  
Author(s):  
Samer S.S. Mahmoud ◽  
Mohamed Sukeik ◽  
Sulaiman Alazzawi ◽  
Mohammed Shaath ◽  
Omar Sabri
Keyword(s):  
Antibiotic Therapy ◽  
Health Care Systems ◽  
Joint Infection ◽  
Resection Arthroplasty ◽  
Surgical Interventions ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Prosthetic Joint ◽  
Care Systems ◽  
Suppressive Antibiotic Therapy

Background:The increasing load placed by joint replacement surgery on health care systems makes infection, even with the lowest rates, a serious concern that needs to be thoroughly studied and addressed using all possible measures.Methods:A comprehensive review of the current literature on salvage procedures for recurrent PJIs using PubMed, EMBASE and CINAHL has been conducted.Results:Prolonged suppressive antibiotic therapy (PSAT), resection arthroplasty and arthrodesis were the most common procedures performed. Suppressive antibiotic therapy is based on the use of well tolerated long term antibiotics in controlling sensitive organisms. Resection arthroplasty which should be reserved as a last resort provided more predictable outcomes in the hip whereas arthrodesis was associated with better outcomes in the knee. Various methods for arthrodesis including internal and external fixation have been described.Conclusion:Despite good union and infection control rates, all methods were associated with complications occasionally requiring further surgical interventions.

Continuous Antibiotic Therapy Can Reduce Recurrence of Prosthetic Joint Infection in Patients Undergoing 2-Stage Exchange

2019 ◽  
Vol 34 (4) ◽  
pp. 704-709 ◽  
Author(s):  
Tiziana Ascione ◽  
Giovanni Balato ◽  
Massimo Mariconda ◽  
Renato Rotondo ◽  
Andrea Baldini ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Prosthetic Joint

Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection

2021 ◽  
Vol 384 (21) ◽  
pp. 1991-2001
Author(s):  
Louis Bernard ◽  
Cédric Arvieux ◽  
Benoit Brunschweiler ◽  
Sophie Touchais ◽  
Séverine Ansart ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Prosthetic Joint

Specific microbiology issues relating to prosthetic joint infection

2018 ◽  
pp. 41-50
Author(s):  
Umraz Khan ◽  
Graeme Perks ◽  
Rhidian Morgan-Jones ◽  
Peter James ◽  
Colin Esler ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Therapy ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Antibiotic Use ◽  
Stopping Rules ◽  
Two Stage ◽  
Infected Case ◽  
Prosthetic Joint ◽  
Resistance Approach

This chapter discusses specific microbiology issues relating to prosthetic joint infection (PJI) and includes discussion on antibiotic prophylaxis (including elective joint replacement in the uninfected case), choice of ‘prophylaxis/treatment’ in the infected, or presumed, infected case, a suggested framework for a safe practice, antibiotic use in PJI in the age of resistance, background on rising antibiotic resistance, approach to one- and two-stage surgical management, outpatient antibiotic therapy and when to use it, monitoring/stopping rules, the particular problems of Pseudomonas and Candida in PJI, and myths and facts about what ‘immunosuppression’ actually means in practice (including MRSA), and a conclusion.

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