Effect of Antibiotic Spacer Dosing on Treatment Success in Two-Stage Exchange for Periprosthetic Joint Infection.
J Am Acad Orthop Surg Glob Res Rev
; 8(2)2024 Feb 01.
Article
en En
| MEDLINE
| ID: mdl-38385716
ABSTRACT
INTRODUCTION:
In two-stage exchange for periprosthetic joint infection (PJI), adding antibiotics to cement spacers is the standard of care; however, little is known about optimal dosage. There is emphasis on using >3.6 g of total antibiotic, including ≥2.0 g of vancomycin, per 40 g of cement, but these recommendations lack clinical evidence. We examined whether recommended antibiotic spacer doses affect treatment success.METHODS:
This was a retrospective review of 202 patients who underwent two-stage exchange for PJI from 2004 to 2020 with at least 1-year follow-up. Patients were separated into high (>3.6 g of total antibiotic per 40 g of cement) and low-dose spacer groups. Primary outcomes were overall and infectious failure.RESULTS:
High-dose spacers were used in 80% (162/202) of patients. High-dose spacers had a reduced risk of overall (OR, 0.37; P = 0.024) and infectious (OR, 0.35; P = 0.020) failure for infected primary arthroplasties, but not revisions. In multivariate analysis, vancomycin dose ≥2.0 g decreased the risk of infectious failure (OR, 0.31; P = 0.016), although not overall failure (OR, 0.51; P = 0.147).CONCLUSION:
During two-stage exchange for PJI, spacers with greater than 3.6 g of total antibiotic may reduce overall and infectious failure for infected primary arthroplasties. Furthermore, using at least 2.0 g of vancomycin could independently decrease the risk of infectious failure.
Texto completo:
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Bases de datos:
MEDLINE
Asunto principal:
Artritis Infecciosa
/
Infecciones Relacionadas con Prótesis
Límite:
Humans
Idioma:
En
Revista:
J Am Acad Orthop Surg Glob Res Rev
Año:
2024
Tipo del documento:
Article
País de afiliación:
Canadá