Antibiotic therapy duration for prosthetic joint infections treated by Debridement and Implant Retention (DAIR): Similar long-term remission for 6 weeks as compared to 12 weeks

Chaussade, H.; Uçkay, İlker; Vuagnat, Albert; Druon, J.; Gras, Guillaume; Rosset, Philippe; Lipsky, Benjamin A.; Bernard, Louis

doi:10.1016/j.ijid.2017.08.002

Cited by 72 publications

(57 citation statements)

References 27 publications

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“…The primary outcome is remission at the last follow-up, but the RCT can be adjusted for different important variables, such as the number of surgical debridements, the use of a negative pressure therapy, administration of a parenteral antibiotic regimen, or the total duration of antibiotic therapy. As in many fields of septic orthopedic surgery, the number of surgical debridements does not formally influence remission rates, which has been shown for chronic osteomyelitis [10], septic native joint arthritis [11], fracture device infections [12], infected open fractures [11], or prosthetic joint infections [13]. There is very little evidence to guide surgical treatment of patients who require a single versus multiple debridements.…”

Section: Discussionmentioning

confidence: 99%

“…[23], and Actinomyces or fungi [24]. To cite recent and our own examples of investigations regarding the overall antibiotic duration, sacral osteomyelitis [25], long-bone osteomyelitis [10], fracture device-related infections [12], spondylodiscitis [25], prosthetic joint infections [13], diabetic foot osteomyelitis [26,27], and many more failed to enhance remission rates if antibiotics were prolonged beyond 4-6 weeks, even in the presence of an infected implant. These emerging and relatively short durations are equally acknowledged by international consensus meetings [28] of surgeons and infectious disease physicians who treat these infections and perform research on them.…”

Section: Discussionmentioning

confidence: 99%

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Short postsurgical antibiotic therapy for spinal infections: protocol of prospective, randomized, unblinded, noninferiority trials (SASI trials)

Betz

Uçkay

Schüpbach

et al. 2020

Trials

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Background: There are several open scientific questions regarding the optimal antibiotic treatment of spinal infections (SIs) with or without an implant. The duration of postsurgical antibiotic therapy is debated. Methods: We will perform two unblinded randomized controlled trials (RCTs). We hypothesize that shorter durations of systemic antibiotic therapy after surgery for SI are noninferior (10% margin, 80% power, α = 5%) to existing (long) treatment durations. The RCTs allocate the participants to two arms of 2 × 59 episodes each: 3 vs. 6 weeks of targeted postsurgical systemic antibiotic therapy for implant-free SIs or 6 vs. 12 weeks for implant-related SIs. This equals a total of 236 adult SI episodes (randomization scheme 1:1) with a minimal follow-up of 12 months. All participants receive concomitant multidisciplinary surgical, re-educational, internist, and infectious disease care. We will perform three interim analyses that are evaluated, in a blinded analysis, by an independent study data monitoring committee. Besides the primary outcome of remission, we will also assess adverse events of antibiotic therapy, changes of the patient's nutritional status, the influence of immune suppression, total costs, functional scores, and the timely evolution of the (surgical) wounds. We define infection as the presence of local signs of inflammation (pus, wound discharge, calor, and rubor) together with microbiological evidence of the same pathogen(s) in at least two intraoperative samples, and we define remission as the absence of clinical, laboratory, and/or radiological evidence of (former or new) infection. Discussion: Provided that there is adequate surgical debridement, both RCTs will potentially enable prescription of less antibiotics during the therapy of SI, with potentially less adverse events and reduced overall costs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Short postsurgical antibiotic therapy for spinal infections: protocol of prospective, randomized, unblinded, noninferiority trials (SASI trials)

Betz

Uçkay

Schüpbach

et al. 2020

Trials

Self Cite

View full text Add to dashboard Cite

show abstract

“…As in many field of septic orthopedic surgery, the number of surgical debridement does not formally influence remission rates, which has been shown for chronic osteomyelitis [10], septic native joint arthritis [11], fracture device infections [12], infected open fractures [11], or prosthetic joint infections [14]. There is very little evidence to guide surgical treatment of patients who require a single versus multiple debridements.…”

Section: Discussionmentioning

confidence: 99%

Short post-surgical antibiotic therapy in spine infections - prospective, randomized, unblinded, non-inferiority trials (SASI Trials)

Betz

Uçkay

Schüpbach

et al. 2019

Preprint

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Background: There are several open scientific questions regarding the optimal antibiotic treatment of spine infections (SI) with or without an implant. The duration of post-surgical antibiotic therapy is debated. Methods: We will perform and perform two unblinded randomized -controlled RCTs. We hypothesize that shorter durations of systemic antibiotic therapy after surgery for SI are non-inferior (10% margin, 80% power, ɑlpha 5%) to existing (long) treatment durations. The RCTs allocate the participants in two arms of 2 x 59 episodes each: 3 vs. 6 weeks of targeted post-surgical systemic antibiotic therapy for implant-free spine infections (two positive microbiological samples); or 6 vs. 12 weeks for implant-related spine infections. This equals a total of 236 adult SI episodes (randomization schemes 1:1) with a minimal follow-up of 12 months. All participants have a concomitant multidisciplinary surgical, re-educational, internist and infectious diseases care. We perform three interim analyses that are evaluated by an independent Study Data Monitoring Committee. Besides the primary outcome remission, we also assess adverse events of antibiotic therapy, changes of the patient’s nutritional status, total costs, functional scores, and the timely evolution of the (surgical) wounds. We define infection as the presence of local signs of inflammation (pus, wound discharge, calor, rubor, pain) together with microbiological evidence of the same pathogen(s) in at least two intraoperative samples; and remission as the absence of any clinical, laboratory and/or radiological evidence of (former or new) infection. Discussion: Provided that there is adequate surgical debridement, both RCTs enable to potentially prescribe less antibiotics during the therapy of SI; with potentially less adverse events and reduced overall costs. Trial registration: ClinicalTrial.gov NCT0408304. Registered on 6 th August 2019. Protocol version : 2 (5 th July 2019)

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“…One primary focus currently for oral antibiotic use after DAIR is the duration of therapy. Although IDSA recommends 6 months, some studies such as Chaussade et al 70 have shown that antimicrobial therapy can be reduced to 6 to 12 weeks for specific microorganisms after DAIR due to the high oral bioavailability of drugs such as fluoroquinolones and rifampin. Additionally, they showed similar results to the OVIVA trial, 20 that IV antibiotics had similar rates of infection remission as oral antibiotics.…”

Section: Prophylactic Oral Antibiotics After Outpatient Primary Tkamentioning

confidence: 99%

Extended Oral Antibiotics and Infection Prophylaxis after a Primary or Revision Total Knee Arthroplasty

2019

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One of the most common reasons for failure of primary total knee arthroplasty and need for revision surgery is periprosthetic infection. Antibiotics are one of the mainstays of treatment to address prosthetic joint infections, but the route of administration and timing of delivery to optimize patient outcomes are debated. This article reviews the use and attributes of commonly used oral antibiotics, especially extended or long-term utilization, as prophylaxis and treatment for prosthetic joint infections in a primary or revision total knee arthroplasty, which include debridement, antibiotics, and implant retention, one-stage and two-stage exchange arthroplasty.

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Antibiotic therapy duration for prosthetic joint infections treated by Debridement and Implant Retention (DAIR): Similar long-term remission for 6 weeks as compared to 12 weeks

Abstract: In patients undergoing DAIR for hip or knee PJI, the likelihood of long-term remission was not significantly different for those receiving 6 versus 12 weeks of antibiotic therapy. Prospective randomized trials are required to confirm this observation.

Cited by 72 publications

References 27 publications

Short postsurgical antibiotic therapy for spinal infections: protocol of prospective, randomized, unblinded, noninferiority trials (SASI trials)

Short postsurgical antibiotic therapy for spinal infections: protocol of prospective, randomized, unblinded, noninferiority trials (SASI trials)

Short post-surgical antibiotic therapy in spine infections - prospective, randomized, unblinded, non-inferiority trials (SASI Trials)

Extended Oral Antibiotics and Infection Prophylaxis after a Primary or Revision Total Knee Arthroplasty

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