Inadequate empirical antibiotics following debridement for orthopedic infections do not increase therapy failures
<p><strong>Introduction</strong>: Empirical antibiotics should only target the most likely pathogens if antibiotic stewardship is being heeded. However, there is a drive for broader-spectrum empirical antibiotics in orthopedic infections due to the concern of therapeutic failure if...
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| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Copernicus Publications
2025-08-01
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| Series: | Journal of Bone and Joint Infection |
| Online Access: | https://jbji.copernicus.org/articles/10/285/2025/jbji-10-285-2025.pdf |
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| Summary: | <p><strong>Introduction</strong>: Empirical antibiotics should only target the most likely pathogens if antibiotic stewardship is being heeded. However, there is a drive for broader-spectrum empirical antibiotics in orthopedic infections due to the concern of therapeutic failure if a regimen fails to target subsequently identified pathogens. <strong>Methods</strong>: Retrospective case-control study with surgically managed orthopedic infections from July 2018 to June 2024 with a minimum follow-up of 6 months. Patients were stratified by the initial empirical treatment of either accurate empirical choice or inaccurate empirical choice. <strong>Results</strong>: Of 482 infection episodes, 79 antibiotic regimens (43 broad-spectrum; 9 %) were used with a median postoperative duration of 42 d (interquartile range 19–45 d); 290 infection episodes (60 %) were correctly targeted. In 192 cases (40 %), the initial empirical choice was inaccurate, with a median switching time to a targeted treatment of 4 d. There was no difference between accurate and inaccurate empirical treatment in terms of ultimate failures (18/290 vs. 15/192; Pearson <span class="inline-formula"><i>χ</i><sup>2</sup></span> test, <span class="inline-formula"><i>p</i>=0.49</span>), overall adverse events of therapy (15 % vs. 7 %, <span class="inline-formula"><i>p</i>=0.11</span>), duration of hospital stay (median 9 d vs. 9 d, <span class="inline-formula"><i>p</i>=0.96</span>), or supplementary surgical debridement (median 0 vs. 0 intervention, <span class="inline-formula"><i>p</i>=0.58</span>). In multivariate logistic regression analysis, the duration of an inaccurate antibiotic treatment failed to alter the risk of “failures” (odds ratio 0.9, 95 % confidence interval 0.8–1.1). <strong>Conclusions</strong>: A delay in commencing targeted antibiotics does not increase the risk of a negative outcome. Narrower-spectrum empirical regimens are appropriate for clinically mild to moderate infections as a broader spectrum does not provide any clinical advantage.</p> |
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| ISSN: | 2206-3552 |