Short-course antibiotics for prosthetic joint infections treated with prosthesis retention

Abstract

The purpose of the present study was to evaluate the significance of shortening the antibiotic treatment duration in prosthetic joint infections (PJI) treated with debridement, antibiotics and implant retention (DAIR). In April 2006 we shortened the total antibiotic treatment duration in total knee arthroplasty (TKA) PJIs from 6 months to 3 months and in total hip arthroplasty (THA) PJIs from 3 months to 2 months. All patients with TKA or THA PJI treated with DAIR between February 2001 and August 2009 were reviewed retrospectively. There were 132 patients treated with DAIR, of whom 86 (65%) completed the antibiotic therapy and were therefore eligible for comparison concerning the length of antibiotic treatment. There were 32 (37%) THA and 54 (63%) TKA PJIs in the comparison. The treatment succeeded in 34 (89.5%) patients treated with longer antibiotic treatment and in 42 (87.5%) of those treated with shorter antibiotic treatment (p 0.78). Our conclusion is that if the patient completes the antibiotic therapy, treatment duration of 3 months in TKA PJIs and 2 months in THA PJIs is as good as longer antibiotic treatment of 6 months or 3 months, respectively, in patients treated with DAIR.

Predictors of treatment outcome in prosthetic joint infections treated with prosthesis retention

“…Before that time, DAIR treatment included antibiotics for six months for total knee arthroplasty (TKA) PJIs and for three months for total hip arthroplasty (THA) PJIs. After April 2006, the duration of antibiotic treatment was reduced to three months for TKA PJIs and two months for THA PJIs as described in our earlier study [4]. We did not find any significant differences between these treatment durations in that study.…”

“…PJI occurs in approximately 0.3-2.2 % of primary arthroplasties and in up to 5.9 % of revision arthroplasties [1][2][3][4]. Clinical practice guidelines from the Infectious Diseases Society of America (IDSA) recommend considering debridement, antibiotics, and implant retention (DAIR) for PJIs when the patient has a well-fixed prosthesis without a sinus tract and is within approximately 30 days of prosthesis implantation or less than three weeks from the onset of infectious symptoms [5].…”

The DAIR (debridement, antibiotics and implant retention) procedure for infected total knee replacement – a literature review

“…Byren et al [48] treated their patients with systemic antibiotics for an average of 1.5 years and cited antibiotic duration as a major risk factor for failure. Puhto et al [49] found no difference in the recurrence of infection when antibiotics were used for three or six months post-procedure, thus advocating shorter duration. Laffer et al [16] showed similar results.…”

Can periprosthetic hip joint infections be successfully managed by debridement and prosthesis retention?

“…However, the purpose of the present study was to evaluate only studies reporting on hip joint infections. Several well-designed studies with a higher level of evidence report about DAIR including both THA and total knee arthroplasty (TKA) cases, whereas a differentiation of the results between both primary surgeries is not possible [15][16][17][18][19][20][21][22][23][24][25][26][27][28] . Similar to that, other studies present data only about small case series [29][30][31] .…”

“…Some authors recommend a duration of antibiotic treatment for 6 mo for TKA-PJIs and 3 mo for THA-PJIs when treated with DAIR [4] . In some recent studies, it has been reported that a shorter course of antibiotics might be also an alternative in DAIR treatment [21,23,28,37] . This confusion regarding the optimal duration of antibiotic therapy is also evident in the present literature review.…”