Suppressive antibiotics beneficial only for some patients with PJI
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Key takeaways:
- Researchers found no overall benefit of routine suppressive antibiotic therapy for patients with PJI.
- This treatment may be more beneficial to patients in the U.S. who have higher rates of treatment failure.
Despite suppressive antibiotic therapy being a routine strategy for managing periprosthetic joint infections, a study showed the benefits may be limited.
“For many clinicians treating periprosthetic joint infections (PJIs), determining the optimal duration of antibiotic therapy remains one of the biggest challenges, especially in cases where the implant has been retained,” Don Bambino Geno Tai, MD, MBA, assistant professor of medicine in the division of infectious diseases and international medicine at the University of Minnesota Medical School, told Healio. “Some clinicians view this situation as requiring indefinite antibiotic therapy, while others believe a fixed treatment duration is appropriate.”
He added that, currently, there is no “strong evidence conclusively favoring either approach.”
To analyze the effect of suppressive antibiotic therapy (SAT) at 12 weeks, Tai and colleagues conducted a multicenter retrospective study assessing patients with acute PJI of the hip or knee who were treated with debridement, antibiotics and implant retention (DAIR) at centers in Europe and the United States.
There was a total of 510 patients included in the study — 167 who received SAT and 343 who did not — with 66 treatment failures reported. Overall, the researchers found no significant association between SAT and treatment failure (HR = 1.37; 95% CI, 0.79-2.39), although they noted that treatment failure occurred in 39 patients on SAT and 27 not on SAT.
Among the subgroup analyses for specific joint, country cohort and type of infection, the study showed no overall benefit for SAT.
However, a secondary analysis of country cohorts was performed after determining that more than half of treatment failures occurred in the U.S. cohort (n = 36). This secondary analysis revealed a trend toward benefit for patients in the U.S. (HR = 0.36; 95% CI, 0.11-1.15).
“Not all patients who undergo DAIR for PJI should receive indefinite suppressive antibiotic therapy after completing the initial 12-week treatment course,” Tai said. “The decision to prescribe long-term suppressive antibiotics should be made carefully, taking into account each individual patient's specific characteristics and risk factors.”
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