Six weeks of antibiotic treatment is sufficient following surgery for septic arthroplasty

Bernard, Louis; Legout, Laurence; Zurcher-Pfund, Line; Stern, Richard; Rohner, Peter; Peter, Robin; Assal, Mathieu; Lew, Daniel Pablo; Hoffmeyer, Pierre; Uckay, Ilker

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Title		Six weeks of antibiotic treatment is sufficient following surgery for septic arthroplasty
Authors		Bernard, Louis Legout, Laurence Zurcher-Pfund, Line Stern, Richard Rohner, Peter Peter, Robin Assal, Mathieu Lew, Daniel Pablo Hoffmeyer, Pierre Uckay, Ilker show all authors [1 - 10]
Published in		Journal of Infection. 2010, vol. 61, no. 2, p. 125-132
Abstract		OBJECTIVES: In the treatment of prosthetic joint infections (PJI), the benefit of antibiotic therapy for more than 6 weeks after surgery is uncertain. We compared PJI cure rates according to the duration of antibiotics, 6 versus 12 weeks. METHODS: A prospective observational non-randomized study in Geneva University Hospitals 1996-2007. RESULTS: A total of 144 PJI (62 hip arthroplasties, 62 knee arthroplasties, and 20 hip hemiarthroplasties) were included with a prolonged follow-up ranging from 26 to 65 months. Surgical treatment included 60 debridements with implant retention, 10 one-stage exchanges of the prosthesis, 57 two-stage exchanges, and 17 Girdlestone procedures or knee arthrodeses. Seventy episodes (49%) received 6 weeks antibiotic therapy and 74 episodes, 12 weeks. Cure was achieved in 115 episodes (80%). Cure rate did not change according to the duration of intravenous antibiotics (>8 days, 8-21 days, >21 days) (Kruskal-Wallis-test; p = 0.37). In multivariate analysis, none of the following parameters was statistically significantly associated with cure: two-stage exchange (odds ratio 1.1,95%CI 0.2-4.8); number of debridements (0.9, 0.4-1.9); six weeks antibiotherapy (2.7, 0.96-8.3); duration of intravenous course (1.0, 0.96-1.03); sinus tract (0.6, 0.2-1.7); or MRSA infection (0.5, 0.2-1.5), although implant retention showed a tendency for less cure (0.3, 0.1-1.1). CONCLUSIONS: Following surgery for treatment of PJI, antibiotic therapy appears able to be limited to a 6-week course, with one week of intravenous administration. This approach needs confirmation in randomized trials.
Keywords		Aged — Aged, 80 and over — Anti-Bacterial Agents/ administration & dosage — Arthritis, Infectious/ surgery — Arthroplasty — Bacterial Infections/ drug therapy — Debridement — Female — Follow-Up Studies — Humans — Male — Prospective Studies — Prosthesis-Related Infections/ drug therapy — Time Factors — Treatment Outcome
Identifiers		DOI: 10.1016/j.jinf.2010.05.005 PMID: 20540962
Full text		Article - Limited access to UNIGE Other version: http://www.sciencedirect.com/science/journal/01634453
Structures		Faculté de médecine / Section de médecine clinique / Département de médecine interne des spécialités Faculté de médecine / Section de médecine clinique / Département de chirurgie Faculté de médecine / Section de médecine clinique
Research groups		Glycopeptide résistance (28) Chirurgie orthopédique et traumatologique (98) Traumatologie ostéoarticulaire (99)
Citation (ISO format)		BERNARD, Louis et al. Six weeks of antibiotic treatment is sufficient following surgery for septic arthroplasty. In: Journal of Infection, 2010, vol. 61, n° 2, p. 125-132. https://archive-ouverte.unige.ch/unige:20772