Long-term antimicrobial suppression prevents treatment failure of streptococcal periprosthetic joint infection - 31/07/19
, Anastasia Rakow, Michael Müller, Carsten Perka, Andrej TrampuzHighlights |
• | Streptococcal periprosthetic joint infections (PJI) are known to have a poor outcome. |
• | Of 65 patients with streptococcal PJI, 58% were infection-free at follow up. |
• | Antimicrobial suppression improved the treatment success significantly. |
• | Suppression was beneficial irrespective of surgical treatment and species. |
Summary |
Objectives |
To evaluate the effect of oral antimicrobial suppression on the outcome of streptococcal periprosthetic joint infection (PJI).
Methods |
Consecutive patients with streptococcal PJI receiving antimicrobial suppression for >6 months were prospectively included and compared to a retrospective control group without suppression. Outcome was assessed with Kaplan-Meier analysis and compared by the log-rank Mantel-Cox test. Multivariate analysis was used to identify factors associated with treatment failure.
Results |
Of 69 streptococcal PJI episodes (37 knee, 31 hip and one shoulder PJI), 43 (62%) were caused by beta-hemolytic streptococci and 26 (38%) by viridans group streptococci. Debridement and prosthesis retention was performed in 27 (39%), one-stage exchange in 5 (7%), multi-stage exchange in 31 (44%) and prosthesis removal in 6 patients (9%). 24 patients (35%) were treated with antimicrobial suppression receiving oral amoxicillin (n = 22), doxycycline (n = 1) or clindamycin (n = 1). After a median follow-up of 13 months (range, 0.5–111 months), 38 of 65 patients (58%) were infection-free. Suppressive antimicrobial treatment was associated with higher success rate compared with no suppression (93% vs. 57%, p = 0.002), representing the only significant independent factor preventing treatment failure.
Conclusions |
Long-term antimicrobial suppression was associated with significantly better treatment outcome and should be strongly considered in streptococcal PJI.
Le texte complet de cet article est disponible en PDF.Keywords : Periprosthetic joint infection, Streptococcus species, Outcome, Biofilms, Suppression
Plan
Vol 79 - N° 3
P. 236-244 - septembre 2019 Retour au numéro
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