Infectious Disease

Oral antibiotics ‘as good as’ IV antibiotics for periprosthetic joint infections

September 06, 2022

2 min read

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Disclosures:
Tai reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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A recent study adds to growing data showing that oral antibiotics are as good as IV antibiotics in periprosthetic joint infection, and the data show that an early switch can be considered in the right scenario.

“I was looking for a topic for my fellowship research. One of the cases I encountered was a patient who developed a periprosthetic joint infection (PJI) after a bout of bacteremia,” Don Bambino Geno Tai, MDinstructor of medicine and infectious diseases fellow at Mayo Clinic, told Healio.

IDN0822Tai_Graphic_01_WEB

Oral antibiotics are as good as IV antibiotics for treating periprosthetic joint infections. Source: Adobe Stock.

“In our discussion during rounds, it became apparent that the antibiotic strategies to treat PJI after debridement and implant retention (DAIR) are not fully evidence based and practice based. “I realized that we could really contribute to the literature and have an impact on the care of our patients,” he said.

The retrospective cohort study focused on patients aged 18 years and older diagnosed with hip and knee PJI who underwent DAIR between Jan. 1, 2008, and Dec. 31, 2018, at the Mayo Clinic. The primary study outcome was failure of DAIR.

Overall, the team examined 247 cases of PJI with a median follow-up of 4.4 years after DAIR. They found that the estimated 5-year cumulative incidence of failure was 28.1% (n = 65).

The study was then assessed in two parts — duration of IV and oral antibiotics and staphylococcal PJI.

Tai and colleagues determined that there was no association between the duration of IV antibiotics and treatment failure (P = .119). However, a shorter duration of subsequent oral antibiotic therapy was associated with a higher risk of failure (HR = 3.50; 95% CI, 1.48-8.25).

“There has been more and more evidence that oral antibiotics are equally effective as IV antibiotics,” Tai said.

However, he noted that this cohort was primarily maintained on indefinite duration of oral antibiotics, preventing an assessment of the optimal duration of chronic suppression.

For staphylococcal knee PJI, the researchers determined that both the use and longer duration of a rifampin-based regimen were associated with a lower risk of failure (P = .025). They added that there was no significant association between fluoroquinolones use and failure (HR = 0.62; 95% CI, 0.31-1.24).

“Overall, the study is consistent with current literature that oral antibiotics are as good as IV antibiotics in PJI,” Tai said. “Early switch can be considered in PJI in the right clinical scenario.”

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