Extended oral antibiotic treatment may reduce recurrent prosthetic joint infections
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Although extended oral antibiotic treatment may reduce the rate of recurrent prosthetic joint infection following two-stage exchange, it may also increase drug resistance to the antibiotic used, according to results.
Laura Certain, MD, PhD, and colleagues retrospectively reviewed data of 211 patients who underwent a two-stage exchange for prosthetic joint infection of the hip or knee between 2014 and 2019. Of the study cohort, 53 patients did not receive oral antibiotics after the stage-two reimplantation and 158 patients received at least 2 weeks of oral antibiotics, according to Certain.
“We looked at two outcomes: the recurrence of [prosthetic joint infection] PJI in the same joint, and also the microbiology of that recurrent infection,” Certain said in her presentation at the Musculoskeletal Infection Society Annual Meeting. “We defined recurrence of PJI clinically, so patients had to have a clinical suspicion of infection. They underwent a debridement surgery and they received a prolonged course of antibiotics. We reasoned that this clinical outcome was what was most relevant from the patient’s perspective.”
Although recurrent PJI was less common among patients who received antibiotics, Certain noted this finding was not statistically significant. She added that her team found no significant difference in the time to recurrent PJI between the two groups, with a median time to recurrent PJI of 3.2 months and 5.7 months among patients who did and those who did not receive antibiotics, respectively. However, Certain said she and colleagues found a difference in the resistance profile between the two groups.
“In the no antibiotic group, there were 11 recurrent PJI but none of them were with any antibiotic-resistant organisms,” Certain said. “But in the patients who had received more than 2 weeks of antibiotics, of those who had a recurrent infection, two-thirds were with an organism that was resistant to whichever antibiotic they had been given.”
Certain noted the difference in resistant organisms between the two groups was primarily caused by a significant increase in the incidence of doxycycline-resistant Staphylococcus epidermidis infections in patients who received prolonged antibiotics.
“This was particularly troubling from an infectious disease physician’s perspective because doxycycline is often one of the antibiotics we use most for patients who need long-term oral antibiotics or if they have recurrent PJI. If you lose doxycycline for Staph epi, you are left with not a lot of oral antibiotic options,” Certain said.
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Kelly M, et al. Paper 809. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 6-7, 2021; Fort Lauderdale, Florida (hybrid meeting).
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