title: Role of Suppressive Oral Antibiotics in Orthopedic Hardware Infections for Those Not Undergoing Two-Stage Replacement Surgery.
abstract: Background.The use of suppressive antibiotics in treatment of orthopedic hardware infections (OHIs), including spinal hardware infections, prosthetic joint infections, and infections of internal fixation devices, is controversial.Methods.Over a 4-year period at 2 academic medical centers, patients with OHI who were treated with debridement and retention of hardware components, with single-stage exchange, or without surgery were studied to determine whether use of oral antibiotics for at least 6 months after diagnosis impacts successful treatment of the infection at 1 year after diagnosis.Results.Of 89 patients in the study, 42 (47.2%) were free of clinical infection 1 year after initial diagnosis. Suppressive antibiotics used for at least 6 months after diagnosis was not associated with being free of clinical infection (adjusted odds ratio [aOR], 5.29; 95% confidence interval [CI], .74-37.80), but being on suppressive antibiotics at least 3 months after diagnosis was associated with being free of clinical infection (OR, 3.50; 95% CI, 1.30-9.43). Causative organisms impacted the likelihood of success; patients with methicillin-resistantStaphylococcus aureusas well as with Gram-negative rods were both less likely to have achieved clinical success at 1 year after surgery (aOR = 0.018, 95% CI = .0017-.19 and aOR = 0.20, 95% CI = .039-.99, respectively).Conclusions.Oral suppressive antibiotic therapy in treatment of OHI with retention of hardware for 3 months, but not 6 months, postdiagnosis increases the likelihood of treatment success. The organisms implicated in the infection directly impact the likelihood of treatment success.
authors.affiliation: Division of Infectious Diseases, Department of Medicine.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Keller
authors.affiliation: Division of Infectious Diseases, Department of Medicine.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Cosgrove
authors.affiliation: Division of Infectious Diseases, Department of Medicine; The Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Division of Infectious Diseases, Department of Medicine.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Higgins
authors.affiliation: Division of Infectious Diseases, Department of Medicine.
authors.forename: Damani A
authors.initials: DA
authors.lastname: Piggott
authors.affiliation: Department of Orthopedic Surgery , Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Greg
authors.initials: G
authors.lastname: Osgood
authors.affiliation: Division of Infectious Diseases, Department of Medicine; The Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Division of Infectious Diseases, Department of Medicine.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Auwaerter
keywords: deep infections of spinal instrumentation; orthopedic hardware infections; prosthetic joint infectious; suppressive antibiotics