A Longer Duration of Intravenous Antibiotic Treatment for Patients with Early Periprosthetic Joint Infections Is Not Associated with a Lower Failure Rate
Background: In recent years, many studies have demonstrated the efficacy of an early switch to oral antibiotics after surgical treatment in orthopedic-related infections. However, large analyses on periprosthetic joint infections (PJIs) are lacking. Material and Methods: We conducted a retrospective...
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MDPI AG
2025-01-01
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| Series: | Antibiotics |
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| author | Janneke Meijer Alex Soriano Wierd Zijlstra Bas ten Have Saad Tarabichi Paul Jutte Javad Parvizi Marjan Wouthuyzen-Bakker |
| author_facet | Janneke Meijer Alex Soriano Wierd Zijlstra Bas ten Have Saad Tarabichi Paul Jutte Javad Parvizi Marjan Wouthuyzen-Bakker |
| author_sort | Janneke Meijer |
| collection | DOAJ |
| description | Background: In recent years, many studies have demonstrated the efficacy of an early switch to oral antibiotics after surgical treatment in orthopedic-related infections. However, large analyses on periprosthetic joint infections (PJIs) are lacking. Material and Methods: We conducted a retrospective observational multicenter study in patients diagnosed with an early post-operative PJI, defined as one occurring <3 months after the index arthroplasty and treated with debridement, antibiotics, and implant retention (DAIR). Patients from Europe and the USA were included. We took advantage of the fact that an early oral antibiotic switch is routine practice in Europe as opposed to a long duration of intravenous (IV) antibiotic treatment in the USA. Failure was defined as the clinical need for (i) a second unintended DAIR procedure, (ii) implant removal, (iii) suppressive antibiotic treatment, or (iii) PJI-related death, all within one year after DAIR. Results: A total of 668 patients were included. A total of 277 received IV antibiotics for <14 days, 232 between 14 and 27 days, and 159 for >27 days. The overall 1-year failure rate within the 3 groups was 41.5%, 44.4%, and 42.1%, respectively (<i>p</i> = 0.80). This observation remained when excluding patients who failed during IV therapy. A longer duration of IV therapy seemed beneficial for those patients with a high pre-operative C-reactive protein level and lack of modular component exchange. Conclusions: In early post-operative PJIs, a longer duration of IV therapy is not associated with a lower failure rate but may be continued until a sufficient bacterial load reduction has been achieved. |
| format | Article |
| id | doaj-art-f21463b0034545bb8d06c1b4d5b02226 |
| institution | Kabale University |
| issn | 2079-6382 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj-art-f21463b0034545bb8d06c1b4d5b022262025-01-24T13:18:53ZengMDPI AGAntibiotics2079-63822025-01-011417910.3390/antibiotics14010079A Longer Duration of Intravenous Antibiotic Treatment for Patients with Early Periprosthetic Joint Infections Is Not Associated with a Lower Failure RateJanneke Meijer0Alex Soriano1Wierd Zijlstra2Bas ten Have3Saad Tarabichi4Paul Jutte5Javad Parvizi6Marjan Wouthuyzen-Bakker7Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The NetherlandsDepartment of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Orthopaedic Surgery, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The NetherlandsDepartment of Orthopaedic Surgery, Martini Hospital, Van Swietenplein 1, 9728 NT Groningen, The NetherlandsDepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USADepartment of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The NetherlandsInternational Joint Center, Acibadem University Hospital, 34303 Istanbul, TurkeyDepartment of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The NetherlandsBackground: In recent years, many studies have demonstrated the efficacy of an early switch to oral antibiotics after surgical treatment in orthopedic-related infections. However, large analyses on periprosthetic joint infections (PJIs) are lacking. Material and Methods: We conducted a retrospective observational multicenter study in patients diagnosed with an early post-operative PJI, defined as one occurring <3 months after the index arthroplasty and treated with debridement, antibiotics, and implant retention (DAIR). Patients from Europe and the USA were included. We took advantage of the fact that an early oral antibiotic switch is routine practice in Europe as opposed to a long duration of intravenous (IV) antibiotic treatment in the USA. Failure was defined as the clinical need for (i) a second unintended DAIR procedure, (ii) implant removal, (iii) suppressive antibiotic treatment, or (iii) PJI-related death, all within one year after DAIR. Results: A total of 668 patients were included. A total of 277 received IV antibiotics for <14 days, 232 between 14 and 27 days, and 159 for >27 days. The overall 1-year failure rate within the 3 groups was 41.5%, 44.4%, and 42.1%, respectively (<i>p</i> = 0.80). This observation remained when excluding patients who failed during IV therapy. A longer duration of IV therapy seemed beneficial for those patients with a high pre-operative C-reactive protein level and lack of modular component exchange. Conclusions: In early post-operative PJIs, a longer duration of IV therapy is not associated with a lower failure rate but may be continued until a sufficient bacterial load reduction has been achieved.https://www.mdpi.com/2079-6382/14/1/79periprosthetic joint infectionantibioticsintravenousoralDAIR |
| spellingShingle | Janneke Meijer Alex Soriano Wierd Zijlstra Bas ten Have Saad Tarabichi Paul Jutte Javad Parvizi Marjan Wouthuyzen-Bakker A Longer Duration of Intravenous Antibiotic Treatment for Patients with Early Periprosthetic Joint Infections Is Not Associated with a Lower Failure Rate Antibiotics periprosthetic joint infection antibiotics intravenous oral DAIR |
| title | A Longer Duration of Intravenous Antibiotic Treatment for Patients with Early Periprosthetic Joint Infections Is Not Associated with a Lower Failure Rate |
| title_full | A Longer Duration of Intravenous Antibiotic Treatment for Patients with Early Periprosthetic Joint Infections Is Not Associated with a Lower Failure Rate |
| title_fullStr | A Longer Duration of Intravenous Antibiotic Treatment for Patients with Early Periprosthetic Joint Infections Is Not Associated with a Lower Failure Rate |
| title_full_unstemmed | A Longer Duration of Intravenous Antibiotic Treatment for Patients with Early Periprosthetic Joint Infections Is Not Associated with a Lower Failure Rate |
| title_short | A Longer Duration of Intravenous Antibiotic Treatment for Patients with Early Periprosthetic Joint Infections Is Not Associated with a Lower Failure Rate |
| title_sort | longer duration of intravenous antibiotic treatment for patients with early periprosthetic joint infections is not associated with a lower failure rate |
| topic | periprosthetic joint infection antibiotics intravenous oral DAIR |
| url | https://www.mdpi.com/2079-6382/14/1/79 |
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