Study: Consider suppressive antibiotic therapy for PJI to maximize survival after TJA
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Key takeaways:
- Suppressive antibiotic therapy should be considered after TJA debridement, antibiotics and implant retention.
- The treatment maximizes reoperation-free survival for patients with PJI.
Surgeons should consider suppressive antibiotic therapy after debridement, antibiotics and implant retention in patients with periprosthetic joint infection to maximize reoperation-free survival, according to published results.
Researchers analyzed outcomes of 115 patients who received suppressive antibiotic therapy after total hip or knee arthroplasty debridement, antibiotics and implant retention (DAIR) for PJI from 2015 to 2020. According to the study, patients received suppressive antibiotic therapy for a mean duration of 11 months. Outcome measures included patient demographics, infecting organisms, antibiotics, adverse drug reactions, intolerances, reoperations and antibiotic resistances.
At a mean follow-up of 2.8 years after DAIR, researchers found reoperation-free survival rates were 83.3% among the total knee arthroplasty DAIR group and 65.1% among the total hip arthroplasty DAIR group. Reoperation risk was highest among patients who underwent TKA for a Staphylococcus aureus infection and lowest among patients who underwent suppressive antibiotic therapy for an increased duration. Researchers noted suppressive antibiotic therapy for an increased duration did not induce antibiotic resistance.
Overall, 11.1% of TKA patients and 16.3% of THA patients who received suppressive antibiotic therapy after DAIR had an adverse drug reaction or intolerance. Researchers noted patients who received trimethoprim, sulfamethoxazole or combination antibiotic therapy after TKA DAIR had an increased risk for an adverse drug reaction or intolerance.
“The optimal duration of [suppressive antibiotic therapy] was nearly 2 years, after which there was no additional benefit to reoperation-free survival,” the researchers wrote in the study. “[Suppressive antibiotic therapy] should be considered in all patients who undergo [total joint arthroplasty] TJA DAIR for acute PJI due to improved reoperation-free survival and favorable safety profile,” they concluded.
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