What are effective strategies for treating a patient with recurrent prosthetic joint infections (PJI)?
Solving the Problem of Chronic Prosthetic Joint Infection
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#prostheticjointinfectionsSecondary#chronicantibioticsuppression
Is, for example, chronic antibiotic suppression a solid treatment option in total joint arthroplasty? This is what a team of researchers from Illinois sought to determine. Their study, “Predictors of Success with Chronic Antibiotic Suppression for Prosthetic Joint Infections,” appears in the February 7, 2022 edition of The Journal of Arthroplasty.
Co-author Rebecca Burr, M.D., with the Department of Orthopaedic Surgery and Rehabilitation at Loyola University Medical Center explained the objective of this study to OTW. “Recurrent infection in total joint arthroplasty after attempted surgical management remains a problem. Chronic antibiotic suppression is an alternative option for a small subset of these patients, however there is limited existing literature on outcomes and predictors of success when chronic suppression is used.”
The researchers collected data for 45 prosthetic joint infections (31 knees, 14 hips) that were managed with chronic antibiotic suppression (median follow-up of 50 months).
“Chronic antibiotic suppression was considered successful if the patient did not require reoperation after starting chronic antibiotic suppression therapy,” said the researchers. “Chronic antibiotic suppression was considered a failure if the patient underwent reoperation after starting chronic antibiotic suppression therapy or if they died of causes directly related to their PJI.”
The overall success rate of managing prosthetic joint infections with this treatment was 67% (30/45). “The chronic antibiotic suppressive regimen, dosing, and monitoring for patients included in this study were predominantly managed by the infectious disease team,” wrote the authors.
Dr. Burr explained further the study outcomes to OTW, “Chronic antibiotic suppression is a reasonable option for patients with persistent infections after total joint arthroplasty who are unable or unwilling to have additional surgery. Most hips and gram-positive infections treated with chronic antibiotic suppression were able to successfully avoid reoperation. Antibiotics were well tolerated in our cohort, and severe side effects were rare.”
“Our time to event analysis for various patient and infection scenarios enables surgeons to provide improved guidance and expectations to patients with this problem. Our goal wasn’t to advocate for a specific treatment, but rather to report the results of our cohort of patients where suppression was given and leave the conclusion to the readers.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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