DAIR TO STOP: SUPPRESSIVE ANTIBIOTIC TREATMENT AFTER 12 WEEKS OF THERAPY IS NOT BENEFICIAL FOR ACUTE PERIPROSTHETIC JOINT INFECTIONS

Tai G, Tande A, Langworthy B, et al. DAIR TO STOP: SUPPRESSIVE ANTIBIOTIC TREATMENT AFTER 12 WEEKS OF THERAPY IS NOT BENEFICIAL FOR ACUTE PERIPROSTHETIC JOINT INFECTIONS. Orthop Procs. 2023;105-B(SUPP_17):82-82. doi:10.1302/1358-992X.2023.17.082

Tai, Geno, et al. “DAIR TO STOP: SUPPRESSIVE ANTIBIOTIC TREATMENT AFTER 12 WEEKS OF THERAPY IS NOT BENEFICIAL FOR ACUTE PERIPROSTHETIC JOINT INFECTIONS.” Orthopaedic Proceedings, vol. 105-B, no. SUPP_17, 2023, pp. 82-82., https://doi.org/10.1302/1358-992X.2023.17.082

Tai, G., Tande, A., Langworthy, B., Have, B. T., Jutte, P., Zijlstra, W., Soriano, A., & Wouthuyzen-Bakker, M. (2023). DAIR TO STOP: SUPPRESSIVE ANTIBIOTIC TREATMENT AFTER 12 WEEKS OF THERAPY IS NOT BENEFICIAL FOR ACUTE PERIPROSTHETIC JOINT INFECTIONS. Orthopaedic Proceedings, 105-B(SUPP_17), 82-82. https://doi.org/10.1302/1358-992X.2023.17.082

Tai, G., Tande, A., Langworthy, B., Have, B. T., Jutte, P., Zijlstra, W. et al. (2023) “DAIR TO STOP: SUPPRESSIVE ANTIBIOTIC TREATMENT AFTER 12 WEEKS OF THERAPY IS NOT BENEFICIAL FOR ACUTE PERIPROSTHETIC JOINT INFECTIONS.” Orthopaedic Proceedings, 105-B(SUPP_17), pp. 82-82. Available at: https://doi.org/10.1302/1358-992X.2023.17.082

Tai, Geno, Aaron Tande, Benjamin Langworthy, Bas Ten Have, Paul Jutte, Wierd Zijlstra, Alex Soriano, and Marjan Wouthuyzen-Bakker. “DAIR TO STOP: SUPPRESSIVE ANTIBIOTIC TREATMENT AFTER 12 WEEKS OF THERAPY IS NOT BENEFICIAL FOR ACUTE PERIPROSTHETIC JOINT INFECTIONS.” Orthopaedic Proceedings 105-B, no. SUPP_17 (2023): 82-82. https://doi.org/10.1302/1358-992X.2023.17.082

Tai G, Tande A, Langworthy B, Have BT, Jutte P, Zijlstra W, et al. DAIR TO STOP: SUPPRESSIVE ANTIBIOTIC TREATMENT AFTER 12 WEEKS OF THERAPY IS NOT BENEFICIAL FOR ACUTE PERIPROSTHETIC JOINT INFECTIONS. Orthop Procs. 2023 Nov 24;105-B(SUPP_17):82-82. https://doi.org/10.1302/1358-992X.2023.17.082

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Abstract

Aim

Debridement, antibiotics, and implant retention (DAIR) is a viable treatment option for acute periprosthetic joint infections (PJI). The landmark DATIPO trial of Bernard et al. concluded that six weeks is not non-inferior to 12-week antibiotic therapy for DAIR. However, it is unknown if suppressive antibiotic treatment (SAT) would improve patient outcomes. Therefore, our study aims to evaluate the utility of SAT after 12 weeks of therapy.

Method

We performed a retrospective study of patients with acute hip or knee PJI managed with DAIR at five institutions; in the U.S. (n=1), Netherlands (n=3), and Spain (n=1) from 2005–2020. We analyzed the effect of SAT using a Cox model among patients after 12 weeks of antibiotic treatment. The primary covariate of interest was whether the patient was on antibiotics after week 12, which was coded as a time-varying covariate. We decided a-priori to control for the clinically important risk factors such as age, sex, type of infection, modular exchange, joint, and presence of bacteremia and Staphylococcus aureus. We excluded patients who died, had treatment failure, or were lost to follow-up before 12 weeks. We defined treatment failure as infection recurrence (same or different organism), unexpected reoperation, or death due to infection.

Results

There were 504 patients included in the study. The majority were female (58%, n=292), with a mean age of 70 years ago (SD 11). Hips and knees were equally proportioned. Primary arthroplasties represented 69% of the total cohort (n=349). Treatment failure was 11.9% in the total cohort (n=60). There was no statistically significant association between SAT after 12 weeks and treatment failure (HR 1.25, p=0.45, 95% CI 0.70–2.24). This finding was consistent across different subgroups, including hip or knee joints, early or late acute infections, cohort, and a subgroup of knee joints after 180 days.