Abstract
Aim
Revision surgery and debridement and implant retention are recognised approaches for managing prosthetic joint infections (PJI) but may not always be indicated. If the patient is unable to have or declines surgery, prolonged suppressive antibiotic therapy (PSAT) is an option. This study aims to define outcomes of PSAT from a single unit.
Method
A retrospective study was performed. All cases of PJI involving the hip or knee between 2012 and 2017 were identified from our institutional database and cross referenced with patient notes. One hundred and seventy eight cases were identified. Of these, 23 (12.9%) (10 hips, 13 knees) were treated with PSAT. Infection was diagnosed based on the MSIS criteria in all cases and all cases were managed by a multidisciplinary team which included specialist microbiologists.
One case of long term antifungal therapy was additionally identified. Co-morbidity was assessed using the Charlson co-morbidity index.
Exacerbations of infection and need for further surgery were recorded.
Results
The mean age was 72 years (Range 35–93 years). The mean Charlson-score was 4.3 (range 1–7). Mean follow up was 24 months (Range 1–54 months). Antibiotics were commenced within 3 months of surgery in 20 cases and between 2 and 4 year following surgery in the remainder. Prolonged antibiotic therapy followed debridement and implant retention in 12 cases, single stage revision in 4 cases and 2 stage revisions in 3 cases. The average number of surgical procedures undergone by each patient prior to starting antibiotic suppression therapy was 1.8 (Range 1–4 procedures).
Staphylococcal species were isolated in 13 cases (MRSA 1, MSSA 5, Staph. Epidermidis 5, CONS 1, Staph Pasteuri 1). Escherichia Coli and Streptococci were isolated in 2 cases each. Four cases were due to polymicrobial infection. No organisms were identified in 2 cases. Candida Albicans was identified in 1 case.
All cases of infection were treated with prolonged oral antibiotics. Twenty patients (87%) received 6 weeks of intravenous antibiotics prior to commencing prolonged oral antibiotics.
Two patients experienced persistent symptoms and required amputation (both TKA). One immunocompromised patient required admission for sepsis related to their infected TKA.
The success rate of long term suppressive antibiotics was 87% (20/23) successful at an average 2 year follow up.
There was persistent wound discharge in 1 case (4.3%).
Conclusions
Prolonged suppressive antibiotic therapy is an effective option for management of PJI and related symptoms with a low incidence of complications in surgically resistant PJI.
