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Suppressive Antibiotic Therapy After Debridement, Antibiotics, and Implant Retention is Well-Tolerated Without Inducing Resistance: A Multicenter Study.
Nandi, Sumon; Doub, James B; De Palma, Brian J; Potter, Genna R; Stronach, Benjamin M; Stambough, Jeffrey B; Brilliant, Zachary R; Mears, Simon C.
Afiliação
  • Nandi S; Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.
  • Doub JB; Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.
  • De Palma BJ; Department of Orthopaedics, University of Maryland Medical Center, Baltimore, Maryland.
  • Potter GR; Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
  • Stronach BM; Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
  • Stambough JB; Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
  • Brilliant ZR; Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.
  • Mears SC; Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
J Arthroplasty ; 39(3): 795-800, 2024 Mar.
Article em En | MEDLINE | ID: mdl-37717831
BACKGROUND: Suppressive antibiotic therapy (SAT) after total joint arthroplasty (TJA) debridement, antibiotics, and implant retention (DAIR) maximizes reoperation-free survival. We evaluated SAT after DAIR of acutely infected primary TJA regarding: 1) adverse drug reaction (ADR)/intolerance; 2) reoperation for infection; and 3) antibiotic resistance. METHODS: Patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) DAIR for acute periprosthetic joint infection at two academic medical centers from 2015 to 2020 were identified (n = 115). Data were collected on patient demographics, infecting organisms, antibiotics, ADR/intolerances, reoperations, and antibiotic resistances. Median SAT duration was 11 months. Stepwise multivariate logistic regressions were used to identify covariates significantly associated with outcomes of interest. RESULTS: There were 11.1 and 16.3% of TKA and THA DAIR patients, respectively, who had ADR/intolerance to SAT. Patients prescribed trimethoprim/sulfamethoxazole (P = .0014) or combination antibiotic therapy (P = .0169) after TKA DAIR had increased risk of ADR/intolerance. There was no difference in reoperation-free survival between TKA (83.3%) and THA (65.1%) DAIR (P = .5900) at mean 2.8-year follow-up. Risk of reoperation for infection was higher among TKA Staphylococcus aureus infections (P = .0004) and lower with increased SAT duration (P < .0450). The optimal duration of SAT was nearly 2 years. No cases of antibiotic resistance developed due to SAT. CONCLUSIONS: Consider SAT after TJA DAIR due to improved reoperation-free survival and favorable safety profile. Prolonged SAT did not induce antibiotic resistance. Use trimethoprim/sulfamethoxazole with caution because of the increased likelihood of ADR/intolerance. LEVEL OF EVIDENCE: Therapeutic Level III.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções Relacionadas à Prótese / Antibacterianos Tipo de estudo: Clinical_trials Limite: Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções Relacionadas à Prótese / Antibacterianos Tipo de estudo: Clinical_trials Limite: Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article