Outcome of patients over 80 years of age on prolonged suppressive antibiotic therapy for at least 6 months for prosthetic joint infection.

March 18, 2015 at 3:38 pm

Int J Infect Dis. 2014 Dec;29:184-9.

Prendki V1, Zeller V2, Passeron D3, Desplaces N4, Mamoudy P3, Stirnemann J5, Marmor S3, Ziza JM6.

1Department of Internal Medicine, Rehabilitation and Geriatrics, Hôpitaux Universitaires de Genève, Hôpital des Trois-Chêne, Chemin de Pont Bochet, 1226 Thônex, Switzerland; Department of Internal Medicine and Rheumatology, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France; Centre de Référence pour les Infections Ostéo Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France. Electronic address: virginie.prendki@hcuge.ch.

2Department of Internal Medicine and Rheumatology, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France; Centre de Référence pour les Infections Ostéo Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France; Department of Orthopaedic Surgery, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France.

3Centre de Référence pour les Infections Ostéo Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France; Department of Orthopaedic Surgery, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France.

4Centre de Référence pour les Infections Ostéo Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France; Biological Laboratory, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France.

5Department of Internal Medicine, Rehabilitation and Geriatrics, Hôpitaux Universitaires de Genève, Hôpital des Trois-Chêne, Chemin de Pont Bochet, 1226 Thônex, Switzerland.

6Department of Internal Medicine and Rheumatology, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France; Centre de Référence pour les Infections Ostéo Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France.

Abstract

OBJECTIVES:

To describe elderly patients treated with prolonged suppressive antibiotic therapy for a prosthetic joint infection (PJI) in cases where the infected prosthesis could not be removed.

METHODS:

All patients aged ≥80 years with a documented PJI and treated with prolonged suppressive antibiotic therapy for more than 6 months were included retrospectively in this study. The following events were noted: failure including persisting infection, relapse, new infection, treatment discontinuation due to severe adverse events, and related death, and also unrelated death.

RESULTS:

Thirty-eight patients with a median age of 84 years (80-95 years) were included; there were 24 hip infections, 13 knee infections, and one shoulder infection. The main causative organisms were Staphylococcus aureus (39%) and Streptococcus agalactiae (16%). The most commonly prescribed antibiotics as prolonged suppressive therapy were penicillins. The median follow-up duration was 24 months; 60% of the patients were event-free at 24 months and were still on prolonged suppressive antibiotic therapy. Fifteen events (six failures and nine unrelated deaths) were observed. Hypoalbuminaemia, the presence of a sinus tract, and a staphylococcal PJI were associated with an increased risk of an event.

CONCLUSIONS:

Prolonged suppressive antibiotic therapy is an alternative therapy in elderly patients with PJI when surgery is contraindicated and when the bacteria are susceptible to well-tolerated oral antimicrobial therapy such as beta-lactams.

PDF

http://www.ijidonline.com/article/S1201-9712(14)01659-2/pdf

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Entry filed under: Antimicrobianos, Bacterias, Health Care-Associated Infections, Infecciones nosocomiales, Infecciones osteo-articulares-musculares, Infecciones relacionadas a prótesis, Metodos diagnosticos, Sepsis.

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