Extended antibiotics effective in patients at high risk for PJI through 1-year follow-up
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Extending oral antibiotics use to 7 days postoperatively in patients at high risk for prosthetic joint infection was effective at reducing infection rates, findings of a retrospective study of prospectively collected data showed.
Michael M. Kheir, MD, presented these findings at the Musculoskeletal Infection Society Annual Meeting, which was held as a virtual meeting.
He said, “Extended oral antibiotics for 7 days postoperatively led to a statistically significant and clinically meaningful reduction in 1-year [prosthetic joint infection] PJI rates for high-risk patients.”
After exclusions were done, Kheir and colleagues analyzed data of 3,862 patients who underwent consecutive total joint arthroplasty at the same hospital with the same protocols. Researchers categorized patients as group A, at low-risk for PJI and receiving only IV antibiotics perioperatively, which is the standard of care; group B, being at high-risk for PJI and receiving only IV antibiotics perioperatively as well; and group C, being at high-risk for PJI and receiving extended oral antibiotics for 7 days postoperatively after the perioperative IV antibiotics.
High-risk patients in group C, in which the researchers were most interested, were patients with one of six major risk factors, such as BMI of 35 kg/m2 or greater, diabetes mellitus and active smokers, Kheir said.
“When stratified by group, high-risk patients who received extended antibiotics – group C – had significantly lower infection rates than high-risk patients who did not get extended antibiotics, group B. Interestingly, there was no difference in the infection rate between group C and low-risk patients in group A. In fact, group C did better than the low-risk group, although not statistically significant,” he said.
At 1-year follow-up, the PJI rates by group were 1.29%, 2.64% and 0.89% for patients in groups A, B and C, respectively, according to data in a slide Kheir showed during the presentation.
Among other findings were results of a covariate analysis in which “we found a significant relationship between joint type and infection, with hips having a higher infection rate than knees,” Kheir said.
He concluded, “The number needed to treat was 57 patients to prevent one PJI. In fact, the PJI rate was equivalent to that seen in low-risk patients, therefore extended oral antibiotic prophylaxis may be a simple measure to effectively counteract poor host factors which can be difficult to modify or optimize.”
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Kheir MM, et al. Presentation 51. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 7-8, 2020 (virtual meeting).
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