Effect of oral antibiotics after two-stage revision for periprosthetic joint infection on subsequent antibiotic resistance within a national cohort of United States veterans
<p><strong>Background</strong>: Prior studies have indicated that administration of prolonged courses of oral antibiotics after Stage 2 reimplantation surgery for periprosthetic joint infection (PJI) results in a lower rate of recurrent PJI. However, there is concern that this anti...
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Copernicus Publications
2025-02-01
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| Series: | Journal of Bone and Joint Infection |
| Online Access: | https://jbji.copernicus.org/articles/10/7/2025/jbji-10-7-2025.pdf |
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| author | J. Payne J. Payne J. D. Sutton B. E. Blackburn S. Bansod S. Bansod H. Imlay H. Imlay E. S. Spivak E. S. Spivak J. Pupaibool J. Pupaibool J. M. Gililland J. M. Gililland L. K. Certain L. K. Certain L. K. Certain |
| author_facet | J. Payne J. Payne J. D. Sutton B. E. Blackburn S. Bansod S. Bansod H. Imlay H. Imlay E. S. Spivak E. S. Spivak J. Pupaibool J. Pupaibool J. M. Gililland J. M. Gililland L. K. Certain L. K. Certain L. K. Certain |
| author_sort | J. Payne |
| collection | DOAJ |
| description | <p><strong>Background</strong>: Prior studies have indicated that administration of prolonged courses of oral antibiotics after Stage 2 reimplantation surgery for periprosthetic joint infection (PJI) results in a lower rate of recurrent PJI. However, there is concern that this antibiotic usage results in an increased risk of antibiotic resistance in any subsequent PJI that does occur.</p>
<p><strong>Methods</strong>: We retrospectively reviewed patients who underwent Stage 2 reimplantation surgery for PJI within the national Veterans Affairs hospital system of the United States. We compared those who received at least 2 weeks of oral antibiotics after Stage 2 reimplantation to those who did not. The primary outcome was the proportion of organisms resistant to four classes of antibiotics (tetracyclines, fluoroquinolones, oral beta-lactams, and sulfonamides) in recurrent PJI. Secondary outcomes included recurrent PJI and death.</p>
<p><strong>Results</strong>: Of the 605 patients who underwent Stage 2 reimplantation for PJI, 154 patients received at least 14 d of antibiotics after surgery and 451 patients did not. Bacteria causing recurrent PJI in patients who received prolonged antibiotics were more likely to be resistant to tetracyclines and trimethoprim–sulfamethoxazole but not oral beta-lactams or fluoroquinolones. There was no difference in risk of recurrent PJI or death between the two groups.</p>
<p><strong>Conclusions</strong>: Prolonged oral antibiotic treatment after Stage 2 reimplantation increases the risk of antibiotic resistance to some antibiotics in subsequent PJI. We recommend further research to identify the best choice of antibiotic and duration after Stage 2 reimplantation, to maximize benefits while minimizing risks.</p> |
| format | Article |
| id | doaj-art-0375368a8be24fd7b19c9d1979df7fd2 |
| institution | Kabale University |
| issn | 2206-3552 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Copernicus Publications |
| record_format | Article |
| series | Journal of Bone and Joint Infection |
| spelling | doaj-art-0375368a8be24fd7b19c9d1979df7fd22025-02-04T10:14:30ZengCopernicus PublicationsJournal of Bone and Joint Infection2206-35522025-02-011071410.5194/jbji-10-7-2025Effect of oral antibiotics after two-stage revision for periprosthetic joint infection on subsequent antibiotic resistance within a national cohort of United States veteransJ. Payne0J. Payne1J. D. Sutton2B. E. Blackburn3S. Bansod4S. Bansod5H. Imlay6H. Imlay7E. S. Spivak8E. S. Spivak9J. Pupaibool10J. Pupaibool11J. M. Gililland12J. M. Gililland13L. K. Certain14L. K. Certain15L. K. Certain16George E. Wahlen VA Medical Center, Salt Lake City, Utah, United States of AmericaDepartment of Internal Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, United States of AmericaGeorge E. Wahlen VA Medical Center, Salt Lake City, Utah, United States of AmericaDepartment of Orthopaedics, University of Utah, Salt Lake City, Utah, United States of AmericaGeorge E. Wahlen VA Medical Center, Salt Lake City, Utah, United States of AmericaDepartment of Internal Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, United States of AmericaGeorge E. Wahlen VA Medical Center, Salt Lake City, Utah, United States of AmericaDepartment of Internal Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, United States of AmericaGeorge E. Wahlen VA Medical Center, Salt Lake City, Utah, United States of AmericaDepartment of Internal Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, United States of AmericaDepartment of Internal Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, United States of AmericaDepartment of Orthopaedics, University of Utah, Salt Lake City, Utah, United States of AmericaGeorge E. Wahlen VA Medical Center, Salt Lake City, Utah, United States of AmericaDepartment of Orthopaedics, University of Utah, Salt Lake City, Utah, United States of AmericaGeorge E. Wahlen VA Medical Center, Salt Lake City, Utah, United States of AmericaDepartment of Internal Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, United States of AmericaDepartment of Orthopaedics, University of Utah, Salt Lake City, Utah, United States of America<p><strong>Background</strong>: Prior studies have indicated that administration of prolonged courses of oral antibiotics after Stage 2 reimplantation surgery for periprosthetic joint infection (PJI) results in a lower rate of recurrent PJI. However, there is concern that this antibiotic usage results in an increased risk of antibiotic resistance in any subsequent PJI that does occur.</p> <p><strong>Methods</strong>: We retrospectively reviewed patients who underwent Stage 2 reimplantation surgery for PJI within the national Veterans Affairs hospital system of the United States. We compared those who received at least 2 weeks of oral antibiotics after Stage 2 reimplantation to those who did not. The primary outcome was the proportion of organisms resistant to four classes of antibiotics (tetracyclines, fluoroquinolones, oral beta-lactams, and sulfonamides) in recurrent PJI. Secondary outcomes included recurrent PJI and death.</p> <p><strong>Results</strong>: Of the 605 patients who underwent Stage 2 reimplantation for PJI, 154 patients received at least 14 d of antibiotics after surgery and 451 patients did not. Bacteria causing recurrent PJI in patients who received prolonged antibiotics were more likely to be resistant to tetracyclines and trimethoprim–sulfamethoxazole but not oral beta-lactams or fluoroquinolones. There was no difference in risk of recurrent PJI or death between the two groups.</p> <p><strong>Conclusions</strong>: Prolonged oral antibiotic treatment after Stage 2 reimplantation increases the risk of antibiotic resistance to some antibiotics in subsequent PJI. We recommend further research to identify the best choice of antibiotic and duration after Stage 2 reimplantation, to maximize benefits while minimizing risks.</p>https://jbji.copernicus.org/articles/10/7/2025/jbji-10-7-2025.pdf |
| spellingShingle | J. Payne J. Payne J. D. Sutton B. E. Blackburn S. Bansod S. Bansod H. Imlay H. Imlay E. S. Spivak E. S. Spivak J. Pupaibool J. Pupaibool J. M. Gililland J. M. Gililland L. K. Certain L. K. Certain L. K. Certain Effect of oral antibiotics after two-stage revision for periprosthetic joint infection on subsequent antibiotic resistance within a national cohort of United States veterans Journal of Bone and Joint Infection |
| title | Effect of oral antibiotics after two-stage revision for periprosthetic joint infection on subsequent antibiotic resistance within a national cohort of United States veterans |
| title_full | Effect of oral antibiotics after two-stage revision for periprosthetic joint infection on subsequent antibiotic resistance within a national cohort of United States veterans |
| title_fullStr | Effect of oral antibiotics after two-stage revision for periprosthetic joint infection on subsequent antibiotic resistance within a national cohort of United States veterans |
| title_full_unstemmed | Effect of oral antibiotics after two-stage revision for periprosthetic joint infection on subsequent antibiotic resistance within a national cohort of United States veterans |
| title_short | Effect of oral antibiotics after two-stage revision for periprosthetic joint infection on subsequent antibiotic resistance within a national cohort of United States veterans |
| title_sort | effect of oral antibiotics after two stage revision for periprosthetic joint infection on subsequent antibiotic resistance within a national cohort of united states veterans |
| url | https://jbji.copernicus.org/articles/10/7/2025/jbji-10-7-2025.pdf |
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