title: Chronic Suppression of Periprosthetic Joint Infections with Oral Antibiotics Increases Infection-Free Survivorship.
abstract: BACKGROUND
  The clinical benefit of chronic suppression with oral antibiotics as a salvage treatment for periprosthetic joint infection is unclear. The purpose of this study was to compare infection-free prosthetic survival rates between patients who received chronic oral antibiotics and those who did not following irrigation and debridement with polyethylene exchange or two-stage revision for periprosthetic joint infection.
  
  
  METHODS
  We reviewed the records on all irrigation and debridement procedures with polyethylene exchange and two-stage revisions performed at our institution from 1996 to 2010 for hip or knee periprosthetic joint infection. Of 625 patients treated with a total of 655 eligible revisions, ninety-two received chronic oral antibiotics for a minimum of six months and were eligible for inclusion in our study. These patients were compared with a matched cohort (ratio of 1:3) who did not receive chronic oral antibiotics.
  
  
  RESULTS
  The five-year infection-free prosthetic survival rate was 68.5% (95% confidence interval [CI] = 59.2% to 79.3%) for the antibiotic-suppression group and 41.1% (95% CI = 34.9% to 48.5%) for the non-suppression group (hazard ratio [HR] = 0.63, p = 0.008). Stratification by the type of surgery and the infecting organism showed a higher five-year survival rate for the patients in the suppression group who underwent irrigation and debridement with polyethylene exchange (64.7%) compared with those in the non-suppression group who underwent irrigation and debridement with polyethylene exchange (30.4%, p < 0.0001) and a higher five-year survival rate for the patients in the suppression group who had a Staphylococcus aureus infection (57.4%) compared with those in the non-suppression group who had a Staphylococcus aureus infection (40.1%, p = 0.047).
  
  
  CONCLUSIONS
  Chronic suppression with oral antibiotics increased the infection-free prosthetic survival rate following surgical treatment for periprosthetic joint infection. Patients who underwent irrigation and debridement with polyethylene exchange and those who had a Staphylococcus aureus infection had the greatest benefit.
authors.affiliation: Departments of Orthopaedic Surgery (M.B.P.S., A.S., A.K.K., C.A.H., and W.K.B.), Quantitative Health Sciences (C.O'R.), and Infectious Diseases (S.S.), Cleveland Clinic Foundation, Cleveland, OH 44195. E-mail address for M.B.P. Siqueira: bogliom@ccf.org. E-mail address for A. Saleh: anas.ar.saleh@gmail.com. E-mail address for A.K. Klika: klikaa@ccf.org. E-mail address for C. O'Rourke: orourkc@ccf.org. E-mail address for S. Schmitt: schmits@ccf.org. E-mail address for C.A. Higuera: higuerc@ccf.org. E-mail address for W.K. Barsoum: barsouw@ccf.org.
authors.forename: Marcelo B P
authors.initials: MB
authors.lastname: Siqueira
authors.affiliation: Departments of Orthopaedic Surgery (M.B.P.S., A.S., A.K.K., C.A.H., and W.K.B.), Quantitative Health Sciences (C.O'R.), and Infectious Diseases (S.S.), Cleveland Clinic Foundation, Cleveland, OH 44195. E-mail address for M.B.P. Siqueira: bogliom@ccf.org. E-mail address for A. Saleh: anas.ar.saleh@gmail.com. E-mail address for A.K. Klika: klikaa@ccf.org. E-mail address for C. O'Rourke: orourkc@ccf.org. E-mail address for S. Schmitt: schmits@ccf.org. E-mail address for C.A. Higuera: higuerc@ccf.org. E-mail address for W.K. Barsoum: barsouw@ccf.org.
authors.forename: Anas
authors.initials: A
authors.lastname: Saleh
authors.affiliation: Departments of Orthopaedic Surgery (M.B.P.S., A.S., A.K.K., C.A.H., and W.K.B.), Quantitative Health Sciences (C.O'R.), and Infectious Diseases (S.S.), Cleveland Clinic Foundation, Cleveland, OH 44195. E-mail address for M.B.P. Siqueira: bogliom@ccf.org. E-mail address for A. Saleh: anas.ar.saleh@gmail.com. E-mail address for A.K. Klika: klikaa@ccf.org. E-mail address for C. O'Rourke: orourkc@ccf.org. E-mail address for S. Schmitt: schmits@ccf.org. E-mail address for C.A. Higuera: higuerc@ccf.org. E-mail address for W.K. Barsoum: barsouw@ccf.org.
authors.forename: Alison K
authors.initials: AK
authors.lastname: Klika
authors.affiliation: Departments of Orthopaedic Surgery (M.B.P.S., A.S., A.K.K., C.A.H., and W.K.B.), Quantitative Health Sciences (C.O'R.), and Infectious Diseases (S.S.), Cleveland Clinic Foundation, Cleveland, OH 44195. E-mail address for M.B.P. Siqueira: bogliom@ccf.org. E-mail address for A. Saleh: anas.ar.saleh@gmail.com. E-mail address for A.K. Klika: klikaa@ccf.org. E-mail address for C. O'Rourke: orourkc@ccf.org. E-mail address for S. Schmitt: schmits@ccf.org. E-mail address for C.A. Higuera: higuerc@ccf.org. E-mail address for W.K. Barsoum: barsouw@ccf.org.
authors.forename: Colin
authors.initials: C
authors.lastname: O'Rourke
authors.affiliation: Departments of Orthopaedic Surgery (M.B.P.S., A.S., A.K.K., C.A.H., and W.K.B.), Quantitative Health Sciences (C.O'R.), and Infectious Diseases (S.S.), Cleveland Clinic Foundation, Cleveland, OH 44195. E-mail address for M.B.P. Siqueira: bogliom@ccf.org. E-mail address for A. Saleh: anas.ar.saleh@gmail.com. E-mail address for A.K. Klika: klikaa@ccf.org. E-mail address for C. O'Rourke: orourkc@ccf.org. E-mail address for S. Schmitt: schmits@ccf.org. E-mail address for C.A. Higuera: higuerc@ccf.org. E-mail address for W.K. Barsoum: barsouw@ccf.org.
authors.forename: Steven
authors.initials: S
authors.lastname: Schmitt
authors.affiliation: Departments of Orthopaedic Surgery (M.B.P.S., A.S., A.K.K., C.A.H., and W.K.B.), Quantitative Health Sciences (C.O'R.), and Infectious Diseases (S.S.), Cleveland Clinic Foundation, Cleveland, OH 44195. E-mail address for M.B.P. Siqueira: bogliom@ccf.org. E-mail address for A. Saleh: anas.ar.saleh@gmail.com. E-mail address for A.K. Klika: klikaa@ccf.org. E-mail address for C. O'Rourke: orourkc@ccf.org. E-mail address for S. Schmitt: schmits@ccf.org. E-mail address for C.A. Higuera: higuerc@ccf.org. E-mail address for W.K. Barsoum: barsouw@ccf.org.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Higuera
authors.affiliation: Departments of Orthopaedic Surgery (M.B.P.S., A.S., A.K.K., C.A.H., and W.K.B.), Quantitative Health Sciences (C.O'R.), and Infectious Diseases (S.S.), Cleveland Clinic Foundation, Cleveland, OH 44195. E-mail address for M.B.P. Siqueira: bogliom@ccf.org. E-mail address for A. Saleh: anas.ar.saleh@gmail.com. E-mail address for A.K. Klika: klikaa@ccf.org. E-mail address for C. O'Rourke: orourkc@ccf.org. E-mail address for S. Schmitt: schmits@ccf.org. E-mail address for C.A. Higuera: higuerc@ccf.org. E-mail address for W.K. Barsoum: barsouw@ccf.org.
authors.forename: Wael K
authors.initials: WK
authors.lastname: Barsoum
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods; D016022:Case-Control Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D003646:Debridement / Q000379:methods; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007720:Knee Prosthesis / Q000009:adverse effects*; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents