title: Prolonged suppressive antibiotic therapy for prosthetic joint infection in the elderly: a national multicentre cohort study.
abstract: During prosthetic joint infection (PJI), optimal surgical management with exchange of the device is sometimes impossible, especially in the elderly population. Thus, prolonged suppressive antibiotic therapy (PSAT) is the only option to prevent acute sepsis, but little is known about this strategy. We aimed to describe the characteristics, outcome and tolerance of PSAT in elderly patients with PJI. We performed a national cross-sectional cohort study of patients >75 years old and treated with PSAT for PJI. We evaluated the occurrence of events, which were defined as: (i) local or systemic progression of the infection (failure), (ii) death and (iii) discontinuation or switch of PSAT. A total of 136 patients were included, with a median age of 83 years [interquartile range (IQR) 81-88]. The predominant pathogen involved was Staphylococcus (62.1%) (Staphylococcus aureus in 41.7%). A single antimicrobial drug was prescribed in 96 cases (70.6%). There were 46 (33.8%) patients with an event: 25 (18%) with an adverse drug reaction leading to definitive discontinuation or switch of PSAT, 8 (5.9%) with progression of sepsis and 13 died (9.6%). Among patients under follow-up, the survival rate without an event at 2 years was 61% [95% confidence interval (CI): 51;74]. In the multivariate Cox analysis, patients with higher World Health Organization (WHO) score had an increased risk of an event [hazard ratio (HR) = 1.5, p = 0.014], whereas patients treated with beta-lactams are associated with less risk of events occurring (HR = 0.5, p = 0.048). In our cohort, PSAT could be an effective and safe option for PJI in the elderly.
authors.affiliation: Internal Medicine and Rehabilitation Unit, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
authors.forename: V
authors.initials: V
authors.lastname: Prendki
authors.affiliation: Infectious and Tropical Disease Unit, Lyon-1 University, Centre International de Recherche en Infectiologie, Centre CNRS U1111 (INSERM)-UMR5308, ENS de Lyon, UCBL1, Lyon, France.
authors.forename: T
authors.initials: T
authors.lastname: Ferry
authors.affiliation: Department of Orthopaedics and Traumatology, Jean Minjoz University Hospital, Besançon, France.
authors.forename: P
authors.initials: P
authors.lastname: Sergent
authors.affiliation: Internal Medicine Unit, Béziers Hospital, Béziers, France.
authors.forename: E
authors.initials: E
authors.lastname: Oziol
authors.affiliation: Infectious Diseases Unit, Metropole Savoie Hospital, Chambéry, France.
authors.forename: E
authors.initials: E
authors.lastname: Forestier
authors.affiliation: Internal Medicine Unit, Alès-Cevennes Hospital, Alès, France.
authors.forename: T
authors.initials: T
authors.lastname: Fraisse
authors.affiliation: Geriatric Unit, Aix-Les-Bains Hospital, Aix-Les-Bains, France.
authors.forename: S
authors.initials: S
authors.lastname: Tounes
authors.affiliation: Infectious Disease Unit, Cavale Blanche University Hospital, Brest, France.
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authors.initials: S
authors.lastname: Ansart
authors.affiliation: Infectious Disease Unit, Annecy Hospital, Annecy, France.
authors.forename: J
authors.initials: J
authors.lastname: Gaillat
authors.affiliation: Infectious Disease Unit, Henri Duffaut Hospital, Avignon, France.
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authors.initials: S
authors.lastname: Bayle
authors.affiliation: Infectious Disease Unit, Belfort Hospital, Belfort, France.
authors.forename: O
authors.initials: O
authors.lastname: Ruyer
authors.affiliation: Infectious Disease Unit, Belfort Hospital, Belfort, France.
authors.forename: F
authors.initials: F
authors.lastname: Borlot
authors.affiliation: Infectious Disease Unit, Belfort Hospital, Belfort, France.
authors.forename: G
authors.initials: G
authors.lastname: Le Falher
authors.affiliation: Infectious Disease Unit, Belfort Hospital, Belfort, France.
authors.forename: B
authors.initials: B
authors.lastname: Simorre
authors.affiliation: Infectious Disease Unit, Pellegrin Hospital, Bordeaux, France.
authors.forename: F-A
authors.initials: FA
authors.lastname: Dauchy
authors.affiliation: Internal Medicine Unit, Boulogne-Billancourt, France.
authors.forename: S
authors.initials: S
authors.lastname: Greffe
authors.affiliation: Orthopedia Department, Boulogne-Billancourt, France.
authors.forename: T
authors.initials: T
authors.lastname: Bauer
authors.affiliation: Infectious Disease Unit, Brive Hospital, Brive-la-Gaillarde, France.
authors.forename: E N
authors.initials: EN
authors.lastname: Bell
authors.affiliation: Infectious Disease Unit, William Morey Hospital, Chalon sur Saône, France.
authors.forename: B
authors.initials: B
authors.lastname: Martha
authors.affiliation: Infectious Disease Unit, Pasteur Hospital, Colmar, France.
authors.forename: M
authors.initials: M
authors.lastname: Martinot
authors.affiliation: Infectious Disease Unit, Alpes Leman Hospital, Contamine sur Arve, France.
authors.forename: M
authors.initials: M
authors.lastname: Froidure
authors.affiliation: Infectious Disease Unit, Dijon Hospital, Dijon, France.
authors.forename: M
authors.initials: M
authors.lastname: Buisson
authors.affiliation: Orthopedia Department, Dijon Hospital, Dijon, France.
authors.forename: A
authors.initials: A
authors.lastname: Waldner
authors.affiliation: Infectious Disease Unit, Douai Hospital, Douai, France.
authors.forename: X
authors.initials: X
authors.lastname: Lemaire
authors.affiliation: Internal Medicine Unit, Grenoble Hospital, Grenoble, France.
authors.forename: A
authors.initials: A
authors.lastname: Bosseray
authors.affiliation: Infectious Disease Unit, Grenoble Hospital, Grenoble, France.
authors.forename: M
authors.initials: M
authors.lastname: Maillet
authors.affiliation: Saint Maur Nursing Home, La Madeleine, France.
authors.forename: V
authors.initials: V
authors.lastname: Charvet
authors.affiliation: Infectious Disease Unit, André Mignot Hospital, Le Chesnay, France.
authors.forename: A
authors.initials: A
authors.lastname: Barrelet
authors.affiliation: Infectious Disease Unit, Bicêtre University Hospital, Le Kremlin-Bicêtre, France.
authors.forename: B
authors.initials: B
authors.lastname: Wyplosz
authors.affiliation: Geriatric Unit, Bicêtre University Hospital, Le Kremlin-Bicêtre, France.
authors.forename: M
authors.initials: M
authors.lastname: Noaillon
authors.affiliation: Infectious Disease Unit, Dupuytren University Hospital, Limoges, France.
authors.forename: E
authors.initials: E
authors.lastname: Denes
authors.affiliation: Nursing Home, Marseille, France.
authors.forename: E
authors.initials: E
authors.lastname: Beretti
authors.affiliation: Orthopedia Department, Nantes University Hospital, Nantes, France.
authors.forename: M
authors.initials: M
authors.lastname: Berlioz-Thibal
authors.affiliation: Infectious Disease Unit, La Croix Saint Simon Hospital, Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: Meyssonnier
authors.affiliation: Orthopedia Department, Pitié Salpétrière University Hospital, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Fourniols
authors.affiliation: Geriatric Unit, Sainte-Périne Hospital, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Tliba
authors.affiliation: Infectious Disease Unit, Perpignan University Hospital, Perpignan, France.
authors.forename: A
authors.initials: A
authors.lastname: Eden
authors.affiliation: Infectious Disease Unit, Perpignan University Hospital, Perpignan, France.
authors.forename: M
authors.initials: M
authors.lastname: Jean
authors.affiliation: Infectious Disease Unit, Pontchaillou University Hospital, Rennes, France.
authors.forename: C
authors.initials: C
authors.lastname: Arvieux
authors.affiliation: Boucicaut Nursing Home, Rouen, France.
authors.forename: K
authors.initials: K
authors.lastname: Guignery-Kadri
authors.affiliation: Orthopedia Department, Strasbourg University Hospital, Strasbourg, France.
authors.forename: C
authors.initials: C
authors.lastname: Ronde-Oustau
authors.affiliation: Infectious Disease Unit, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Hansmann
authors.affiliation: Infectious Disease Unit, Villeneuve Saint Georges Hospital, Villeneuve Saint Georges, France.
authors.forename: A
authors.initials: A
authors.lastname: Belkacem
authors.affiliation: Pharmacy Department, Raymond Poincaré University Hospital, AP-HP, Garches, France.
authors.forename: F
authors.initials: F
authors.lastname: Bouchand
authors.affiliation: Division of Infectious Diseases, University Hospital of Grenoble-University Clinic of Geriatric Medicine, Grenoble, France.
authors.forename: G
authors.initials: G
authors.lastname: Gavazzi
authors.affiliation: Geriatrics Unit, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Herrmann
authors.affiliation: Internal Medicine Unit, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Stirnemann
authors.affiliation: Division of Infectious Diseases Unit, Raymond Poincaré University Hospital, AP-HP, Garches, France. aurelien.dinh@aphp.fr.|Infectious Disease Unit, University Hospital R. Poincaré, Garches, France. aurelien.dinh@aphp.fr.|Versailles Saint Quentin University, Versailles, France. aurelien.dinh@aphp.fr.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-5843-4819
authors.initials: A
authors.lastname: Dinh
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Adverse Drug Reaction; Antimicrobial Therapy; Fusidic Acid; Prosthetic Joint Infection; Sinus Tract