1. The efficacy of suppressive antibiotic treatment in patients managed non-operatively for periprosthetic joint infection and a draining sinus
- Author
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Lensen K. -J. D. F., Escudero-Sanchez R., Cobo J., Trebse R., Gubavu C., Tedeschi S., Lomas J. M., Arvieux C., Rodriguez-Pardo D., Fantoni M., Pais M. J. G., Jover F., Salles M. J. C., Sancho I., Sampedro M. F., Soriano A., Wouthuyzen-Bakker M., Roskar S., Praena J., Ribeiro T. C., Taccari T., Meheut A., Achermann Y., Andronic O., Asensi V., Moran-Castan C., Jover-Saenz A., Institut Català de la Salut, [Lensen KDF] Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. [Escudero-Sanchez R, Cobo J] Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain. [Trebše R] Service for Bone Infections, Valdoltra Orthopaedic Hospital, Ankaran, Slovenia. [Gubavu C] Department of Infectious and Tropical Diseases, CHR Orléans, Orléans, France. [Tedeschi S] Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Bologna Policlinico di Sant Orsola, Bologna, Italy. [Rodriguez-Pardo D] Servei de Malalties Infeccioses, Vall d'Hebron Hospital Universitari, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, Lensen K.-J.D.F., Escudero-Sanchez R., Cobo J., Trebse R., Gubavu C., Tedeschi S., Lomas J.M., Arvieux C., Rodriguez-Pardo D., Fantoni M., Pais M.J.G., Jover F., Salles M.J.C., Sancho I., Sampedro M.F., Soriano A., Wouthuyzen-Bakker M., Roskar S., Praena J., Ribeiro T.C., Taccari T., Meheut A., Achermann Y., Andronic O., Asensi V., Moran-Castan C., and Jover-Saenz A.
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prothetic joint infections, suppressive antibiotic therapy, draining sinus tract ,medicine.medical_specialty ,medicine.drug_class ,Original Full-Length Article ,Antibiotics ,Periprosthetic ,Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores] ,Other subheadings::Other subheadings::/drug therapy [Other subheadings] ,medicine ,Bacterial Infections and Mycoses::Infection::Prosthesis-Related Infections [DISEASES] ,Orthopedics and Sports Medicine ,In patient ,Prospective cohort study ,Sinus (anatomy) ,Orthopedic surgery ,business.industry ,infecciones bacterianas y micosis::infección::infecciones relacionadas con prótesis [ENFERMEDADES] ,diagnóstico::pronóstico::resultado del tratamiento [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Articulacions artificials ,medicine.disease ,Diagnosis::Prognosis::Treatment Outcome [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,Surgery ,Infectious Diseases ,medicine.anatomical_structure ,Bacteremia ,Avaluació de resultats (Assistència sanitària) ,Infecció ,Implant ,business ,RD701-811 ,Cohort study - Abstract
Objectives: Patients with prosthetic joint infections (PJIs) not suitable for curative surgery may benefit from suppressive antibiotic therapy (SAT). However, the usefulness of SAT in cases with a draining sinus has never been investigated. Methods: A multicentre, retrospective observational cohort study was performed in which patients with a PJI and a sinus tract were eligible for inclusion if managed conservatively and if sufficient follow-up data were available (i.e. at least 2 years). SAT was defined as a period of > 6 months of oral antibiotic therapy. Results: SAT was initiated in 63 of 72 (87.5 %) included patients. Implant retention during follow-up was the same in patients receiving SAT vs. no SAT (79.4 % vs. 88.9 %; p=0.68). In total, 27 % of patients using SAT experienced side effects. In addition, the occurrence of prosthetic loosening in initially fixed implants, the need for surgical debridement, or the occurrence of bacteremia during follow-up could not be fully prevented with the use of SAT, which still occurred in 42 %, 6.3 %, and 3.2 % of cases, respectively. However, the sinus tract tended to close more often (42 % vs. 13 %; p=0.14), and a higher resolution of pain was observed (35 % vs. 14 %; p=0.22) in patients receiving SAT. Conclusions: SAT is not able to fully prevent complications in patients with a draining sinus. However, it may be beneficial in a subset of patients, particularly in those with pain or the hindrance of a draining sinus. A future prospective study, including a higher number of patients not receiving SAT, is needed.
- Published
- 2021