CHRONIC SUPPRESSION WITH ORAL ANTIBIOTICS INCREASES INFECTION-FREE SURVIVORSHIP IN PERIPROSTHETIC JOINT INFECTIONS

C.A. Higuera

doi:10.1302/1358-992X.98BSUPP_22.CCJR2015-027

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General Orthopaedics

CHRONIC SUPPRESSION WITH ORAL ANTIBIOTICS INCREASES INFECTION-FREE SURVIVORSHIP IN PERIPROSTHETIC JOINT INFECTIONS

Current Concepts in Joint Replacement (CCJR) – Winter 2015 meeting (9–12 December).

C.A. Higuera

CHRONIC SUPPRESSION WITH ORAL ANTIBIOTICS INCREASES INFECTION-FREE SURVIVORSHIP IN PERIPROSTHETIC JOINT INFECTIONS

Higuera C. CHRONIC SUPPRESSION WITH ORAL ANTIBIOTICS INCREASES INFECTION-FREE SURVIVORSHIP IN PERIPROSTHETIC JOINT INFECTIONS. Orthop Procs. 2016;98-B(SUPP_22):27-27. doi:10.1302/1358-992X.98BSUPP_22.CCJR2015-027

Higuera, C.A.. “CHRONIC SUPPRESSION WITH ORAL ANTIBIOTICS INCREASES INFECTION-FREE SURVIVORSHIP IN PERIPROSTHETIC JOINT INFECTIONS.” Orthopaedic Proceedings, vol. 98-B, no. SUPP_22, 2016, pp. 27-27., https://doi.org/10.1302/1358-992X.98BSUPP_22.CCJR2015-027

Higuera, C. (2016). CHRONIC SUPPRESSION WITH ORAL ANTIBIOTICS INCREASES INFECTION-FREE SURVIVORSHIP IN PERIPROSTHETIC JOINT INFECTIONS. Orthopaedic Proceedings, 98-B(SUPP_22), 27-27. https://doi.org/10.1302/1358-992X.98BSUPP_22.CCJR2015-027

Higuera, C. (2016) “CHRONIC SUPPRESSION WITH ORAL ANTIBIOTICS INCREASES INFECTION-FREE SURVIVORSHIP IN PERIPROSTHETIC JOINT INFECTIONS.” Orthopaedic Proceedings, 98-B(SUPP_22), pp. 27-27. Available at: https://doi.org/10.1302/1358-992X.98BSUPP_22.CCJR2015-027

Higuera, C.A. “CHRONIC SUPPRESSION WITH ORAL ANTIBIOTICS INCREASES INFECTION-FREE SURVIVORSHIP IN PERIPROSTHETIC JOINT INFECTIONS.” Orthopaedic Proceedings 98-B, no. SUPP_22 (2016): 27-27. https://doi.org/10.1302/1358-992X.98BSUPP_22.CCJR2015-027

Higuera C. CHRONIC SUPPRESSION WITH ORAL ANTIBIOTICS INCREASES INFECTION-FREE SURVIVORSHIP IN PERIPROSTHETIC JOINT INFECTIONS. Orthop Procs. 2016 Dec 1;98-B(SUPP_22):27-27. https://doi.org/10.1302/1358-992X.98BSUPP_22.CCJR2015-027

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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 = 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 = 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.