Chronic Oral Antibiotics Boost 5-Year Infection-Free Implant Survival after Certain PJIs

Along with the sharply rising number of total hip and knee arthroplasties performed in the US comes an increasingly compelling need to prevent periprosthetic joint infections (PJIs). If a PJI occurs, guidelines recommend a two- to six-week post-revision course of pathogen-specific intravenous antibiotic therapy. However, the benefit of chronic suppression with oral antibiotics beyond that is unproven.

In the August 5 edition of The Journal of Bone & Joint Surgery, Siqueira et al. compared the infection-free prosthetic survivorship in 92 patients who underwent chronic oral antibiotic suppression for a minimum of six months with prosthetic survivorship in a matched cohort who did not receive extended antibiotic treatment. In so doing, they also attempted to determine factors associated with failure of chronic suppression with oral antibiotics.

The five-year infection-free prosthetic survival rate in the suppression group was 68.5% compared with 41.1% in the non-suppression group. Patients who benefited the most from chronic suppressive antibiotic therapy were:

  • Those who underwent irrigation and debridement with polyethylene exchange. (Antibiotic suppression following two-stage procedures did not affect prosthetic survival.)
  • Those with Staphylococcus aureus (Chronic antibiotic therapy did not influence infection-free survival after revisions for non-S. aureus infections.)

Suppression-group patients in whom antibiotic treatment failed had had more prior joint revisions and were more likely to have had a knee PJI than a hip infection.

Noting the benefit of suppressive therapy in patients who underwent irrigation and debridement with polyethylene exchange, the authors concluded that “persistence of a latent infection is common in patients with retained implants, and thus antibiotic suppression seems to be a reasonable alternative that avoids the need for a more invasive two-stage revision.”

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