title: Outcome of patients over 80 years of age on prolonged suppressive antibiotic therapy for at least 6 months for prosthetic joint infection.
abstract: OBJECTIVE
  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.
authors.affiliation: Department 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.
authors.forename: Virginie
authors.initials: V
authors.lastname: Prendki
authors.affiliation: 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; Department of Orthopaedic Surgery, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Zeller
authors.affiliation: 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.
authors.forename: Dorick
authors.initials: D
authors.lastname: Passeron
authors.affiliation: Centre 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.
authors.forename: Nicole
authors.initials: N
authors.lastname: Desplaces
authors.affiliation: 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.
authors.forename: Patrick
authors.initials: P
authors.lastname: Mamoudy
authors.affiliation: Department of Internal Medicine, Rehabilitation and Geriatrics, Hôpitaux Universitaires de Genève, Hôpital des Trois-Chêne, Chemin de Pont Bochet, 1226 Thônex, Switzerland.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Stirnemann
authors.affiliation: 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.
authors.forename: Simon
authors.initials: S
authors.lastname: Marmor
authors.affiliation: 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.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Ziza
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D008297:Male; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Elderly people; Oral antimicrobial suppression; Prolonged suppressive antibiotic therapy; Prosthetic joint infection