Six weeks of antibiotic treatment is sufficient following surgery for septic arthroplasty.
OBJECTIVE
In the treatment of prosthetic joint infections (PJI), the benefit of antibiotic therapy for more than 6 weeks after surgery is uncertain. We compared PJI cure rates according to the duration of antibiotics, 6 versus 12 weeks.


METHODS
A prospective observational non-randomized study in Geneva University Hospitals 1996-2007.


RESULTS
A total of 144 PJI (62 hip arthroplasties, 62 knee arthroplasties, and 20 hip hemiarthroplasties) were included with a prolonged follow-up ranging from 26 to 65 months. Surgical treatment included 60 débridements with implant retention, 10 one-stage exchanges of the prosthesis, 57 two-stage exchanges, and 17 Girdlestone procedures or knee arthrodeses. Seventy episodes (49%) received 6 weeks antibiotic therapy and 74 episodes, 12 weeks. Cure was achieved in 115 episodes (80%). Cure rate did not change according to the duration of intravenous antibiotics (>8 days, 8-21 days, >21 days) (Kruskal-Wallis-test; p = 0.37). In multivariate analysis, none of the following parameters was statistically significantly associated with cure: two-stage exchange (odds ratio 1.1,95%CI 0.2-4.8); number of débridements (0.9, 0.4-1.9); six weeks antibiotherapy (2.7, 0.96-8.3); duration of intravenous course (1.0, 0.96-1.03); sinus tract (0.6, 0.2-1.7); or MRSA infection (0.5, 0.2-1.5), although implant retention showed a tendency for less cure (0.3, 0.1-1.1).


CONCLUSIONS
Following surgery for treatment of PJI, antibiotic therapy appears able to be limited to a 6-week course, with one week of intravenous administration. This approach needs confirmation in randomized trials.
Bernard
Louis
L
Orthopaedic Surgery Service, Geneva University Hospitals & Medical School, Geneva, Switzerland.
Legout
Laurence
L
Zürcher-Pfund
Line
L
Stern
Richard
R
Rohner
Peter
P
Peter
Robin
R
Assal
Mathieu
M
Lew
Daniel
D
Hoffmeyer
Pierre
P
Uçkay
Ilker
I
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001170:Arthritis, Infectious / Q000601:surgery*; D001178:Arthroplasty; D001424:Bacterial Infections / Q000188:drug therapy*; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents