Objective: The prevailing treatment for chronic periprosthetic joint infection (PJI) is a two-stage exchange, yet the optimal duration of antibiotic therapy following this procedure remains a topic of debate. This study aimed to determine whether a short course of postoperative antibiotic therapy can maintain infection control rates following a long interval two-stage exchange (LITE) for PJI.
Methods: We conducted a prospective study enrolling patients with chronic PJI who underwent the LITE procedure at our institution from April 2018 to November 2021. Patients were randomly assigned to receive either a long course (12 weeks) or short course (2 weeks) of postoperative antibiotics. The pathogens, antibiotics, inflammatory markers, antibiotic-related complications, cases of reinfection, or re-operation were recorded. Continuous variables were analyzed using the two-sample t-test or Mann–Whitney U test, and categorical variables were analyzed using Fisher’s exact tests. Kaplan–Meier survival analysis was used to compare infection control rates.
Results: A total of 60 patients with chronic PJI who completed the LITE procedure were included in the study (30 patients per group). All patients were followed for a minimum of 24 months (mean 39.2 ± 13.0 months). We observed that the infection control rate in the short-course group was not inferior to that in the long-course group (96.7% vs. 96.7%, p = 1.000).
Conclusions: For patients with chronic PJI undergoing the LITE procedure, a 2-week course of postoperative antibiotics suffices to maintain infection control rates.
Trial Registration: Chinese Clinical Trial Registry: ChiCTR1900027089
| [1] |
E. Kozaily, E. Chisari, and J. Parvizi, “Is There a Role for Spacer Exchange in Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection?,” Journal of Clinical Medicine 9 (2020): 2901,
|
| [2] |
D. T. Tsukayama, R. Estrada, and R. B. Gustilo, “Infection After Total Hip Arthroplasty. A Study of the Treatment of One Hundred and Six Infections,” Journal of Bone and Joint Surgery 78 (1996): 512–523,
|
| [3] |
H. Peng, L. Wang, J. Cheng, et al., “Rates of Periprosthetic Infection and Surgical Revision in Beijing (China) Between 2014 and 2016: A Retrospective Multicenter Cross-Sectional Study,” Journal of Orthopaedic Surgery and Research 14 (2019): 463,
|
| [4] |
I. Vadiee and D. J. Backstein, “The Effectiveness of Repeat Two-Stage Revision for the Treatment of Recalcitrant Total Knee Arthroplasty Infection,” Journal of Arthroplasty 34 (2019): 369–374,
|
| [5] |
A. F. Chen, A. D. Nana, S. B. Nelson, and A. McLaren, “What’s New in Musculoskeletal Infection: Update Across Orthopaedic Subspecialties,” Journal of Bone and Joint Surgery 99 (2017): 1232–1243,
|
| [6] |
S. Esposito, I. Esposito, and S. Leone, “Considerations of Antibiotic Therapy Duration in Community-and Hospital-Acquired Bacterial Infections,” Journal of Antimicrobial Chemotherapy 67 (2012): 2570–2575,
|
| [7] |
A. J. Johnson, M. G. Zywiel, L. C. Jones, R. E. Delanois, D. A. Stroh, and M. A. Mont, “Reduced Re-Infection Rates With Postoperative Oral Antibiotics After Two-Stage Revision Hip Arthroplasty,” BMC Musculoskeletal Disorders 14 (2013): 1–7,
|
| [8] |
Y. JaeWon, P. Javad, E. N. Hansen, et al., “2020 Mark Coventry Award: Microorganism-Directed Oral Antibiotics Reduce the Rate of Failure due to Further Infection After Two-Stage Revision Hip or Knee Arthroplasty for Chronic Infection: A Multicentre Randomized Controlled Trial at a Minimum of Two Years,” Bone & Joint Journal 102 (2020): 3–9,
|
| [9] |
S. Elyasi, H. Khalili, S. Dashti-Khavidaki, and A. Mohammadpour, “Vancomycin-Induced Nephrotoxicity: Mechanism, Incidence, Risk Factors and Special Populations. A Literature Review,” European Journal of Clinical Pharmacology 68 (2012): 1243–1255,
|
| [10] |
F. Bruniera, F. M. Ferreira, L. R. M. Saviolli, et al., “The Use of Vancomycin With Its Therapeutic and Adverse Effects: A Review,” European Review for Medical and Pharmacological Sciences 19 (2015): 694–700,
|
| [11] |
X. Fang, Q. Wang, X. Yang, et al., “What is the Appropriate Extended Duration of Antibiotic Prophylaxis After Two-Stage Revision for Chronic PJI?,” Bone & Joint Research 10 (2021): 790–796,
|
| [12] |
J. Parvizi, T. Gehrke, and A. F. Chen, “Proceedings of the International Consensus on Periprosthetic Joint Infection,” Bone & Joint Journal 95B (2013): 1450–1452,
|
| [13] |
C.-Y. Ma, Y.-D. Lu, K. L. Bell, et al., “Predictors of Treatment Failure After 2-Stage Reimplantation for Infected Total Knee Arthroplasty: A 2-To 10-Year Follow-Up,” Journal of Arthroplasty 33 (2018): 2234–2239,
|
| [14] |
J. M. Frank, T. K. Group, E. Kayupov, et al., “The Mark Coventry, MD, Award: Oral Antibiotics Reduce Reinfection After Two-Stage Exchange: A Multicenter, Randomized Controlled Trial,” Clinical Orthopaedics and Related Research 475 (2016): 56–61,
|
| [15] |
L. Bernard, C. Arvieux, B. Brunschweiler, et al., “Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection,” New England Journal of Medicine 384 (2021): 1991–2001,
|
| [16] |
P. Bejon, A. Berendt, B. L. Atkins, et al., “Two-Stage Revision for Prosthetic Joint Infection: Predictors of Outcome and the Role of Reimplantation Microbiology,” Journal of Antimicrobial Chemotherapy 65 (2010): 569–575,
|
| [17] |
Z. Huang, W. Li, G.-C. Lee, et al., “Metagenomic Next-Generation Sequencing of Synovial Fluid Demonstrates High Accuracy in Prosthetic Joint Infection Diagnostics,” Bone & Joint Research 9 (2020): 440–449,
|
| [18] |
E. A. Masters, B. F. Ricciardi, K. L. M. Bentley, et al., “Skeletal Infections: Microbial Pathogenesis, Immunity and Clinical Management,” Nature Reviews Microbiology 20 (2022): 385–400,
|
| [19] |
T. Konstantinidis, C. Tsigalou, A. Karvelas, E. Stavropoulou, C. Voidarou, and E. Bezirtzoglou, “Effects of Antibiotics Upon the Gut Microbiome: A Review of the Literature,” Biomedicine 8 (2020): 502,
|
| [20] |
S. Iacob, D. G. Iacob, and L. M. Luminos, “Intestinal Microbiota as a Host Defense Mechanism to Infectious Threats,” Frontiers in Microbiology 9 (2019): 1–9,
|
| [21] |
C. J. Hernandez, X. Yang, G. Ji, et al., “Disruption of the Gut Microbiome Increases the Risk of Periprosthetic Joint Infection in Mice,” Clinical Orthopaedics and Related Research 477 (2019): 2588–2598,
|
| [22] |
T.-T. Pham, E. Mabrut, P. Cochard, et al., “Cost of Off-Label Antibiotic Therapy for Bone and Joint Infections: A 6-Year Prospective Monocentric Observational Cohort Study in a Referral Centre for Management of Complex Osteo-Articular Infections,” Journal of Bone and Joint Infection 6 (2021): 337–346,
|
| [23] |
F.-C. Kuo, S.-H. Yen, K.-T. Peng, J. W. Wang, and M. S. Lee, “Methicillin-Resistant Staphylococcal Periprosthetic Joint Infections Can Be Effectively Controlled by Systemic and Local Daptomycin,” BMC Infectious Diseases 16 (2015): 48,
|
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2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
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