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J Arthroplasty ; 39(8S1): S323-S327, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38631513

RESUMO

BACKGROUND: Vancomycin and tobramycin have traditionally been used in antibiotic spacers. In 2020, our institution replaced tobramycin with ceftazidime. We hypothesized that the use of ceftazidime/vancomycin (CV) in antibiotic spacers would not lead to an increase in treatment failure compared to tobramycin/vancomycin (TV). METHODS: From 2014 to 2022, we identified 243 patients who underwent a stage I revision for periprosthetic joint infection. The primary outcome was a recurrent infection requiring antibiotic spacer exchange. We were adequately powered to detect a 10% difference in recurrent infection. Patients who had a prior failed stage I or two-stage revision for infection, acute kidney injury prior to surgery, or end-stage renal disease were excluded. Given no other changes to our spacer constructs, we estimated cost differences attributable to the antibiotic change. Chi-square and t-tests were used to compare the two groups. Multivariable logistic regressions were utilized for the outcomes. RESULTS: The combination of TV was used in 127 patients; CV was used in 116 patients. Within one year of stage I, 9.8% of the TV group had a recurrence of infection versus 7.8% of the CV group (P = .60). By final follow-up, results were similar (12.6 versus 8.6%, respectively, P = .32). Adjusting for potential risk factors did not alter the results. Cost savings for ceftazidime versus tobramycin are estimated to be $68,550 per one hundred patients treated. CONCLUSIONS: Replacing tobramycin with ceftazidime in antibiotic spacers yielded similar periprosthetic joint infection eradication success at a lower cost. While larger studies are warranted to confirm these efficacy and cost-saving results, our data justifies the continued investigation and use of ceftazidime as an alternative to tobramycin in antibiotic spacers.


Assuntos
Antibacterianos , Ceftazidima , Infecções Relacionadas à Prótese , Tobramicina , Vancomicina , Humanos , Tobramicina/administração & dosagem , Tobramicina/economia , Vancomicina/economia , Vancomicina/administração & dosagem , Vancomicina/uso terapêutico , Ceftazidima/administração & dosagem , Ceftazidima/economia , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/economia , Antibacterianos/economia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Reoperação/economia , Resultado do Tratamento , Estudos Retrospectivos , Artroplastia do Joelho/efeitos adversos , Artroplastia de Quadril/instrumentação
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