Management of prosthetic joint infection treated with two-stage exchange: the impact of antimicrobial therapy duration

Odette C. El Helou, Elie F. Berbari, Brian D. Lahr, Camelia E. Marculescu, Raymund R. Razonable, James M. Steckelberg, Arlen D. Hanssen, Douglas R. Osmon

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background: The optimal duration of parenteral antimicrobial therapy in patients with prosthetic joint infection treated with a two-stage exchange is unknown. Methods: This analysis compares the outcomes between patients treated with 4 weeks and those treated with 6 weeks of parenteral antimicrobial therapy after a two-stage exchange for prosthetic joint infection. The medical records of all patients with total knee arthroplasty or total hip arthroplasty infections treated with a two-stage exchange between 1995 and 1999 at our institution were reviewed. Cox regression models were used to compare treatment failure rates between patients who were treated for 4 weeks and those who were treated for 6 weeks with antimicrobial therapy after adjusting for the propensity to be treated for 6 weeks. Results: Two hundred and eight prosthetic joint infections occurred in 201 patients. Thirty-nine percent and 61% of prosthetic joint infections were treated with 4 weeks or 6 weeks of parenteral antimicrobials, respectively. The 5-year success rate was 84% and 73% in the 4-week and 6-week groups, respectively. After adjusting for the propensity to be treated for 6 weeks, there was no significant differences in the treatment failure rates between those treated with 6 weeks of parenteral antimicrobials and those treated with 4 weeks [hazard ratio (HR)=1.4, 95% confidence interval (CI), 0.7-2.7; P=0.31]. Conclusions: Six weeks of parenteral antimicrobials between stages did not decrease the treatment failure rate in patients with prosthetic joint infections compared with 4 weeks of treatment.

Original languageEnglish (US)
Pages (from-to)333-338
Number of pages6
JournalCurrent Orthopaedic Practice
Volume22
Issue number4
DOIs
StatePublished - Jul 1 2011

Keywords

  • Antimicrobial therapy
  • Outcome of prosthetic joint infection
  • Prosthetic joint infection
  • Two-stage exchange

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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    El Helou, O. C., Berbari, E. F., Lahr, B. D., Marculescu, C. E., Razonable, R. R., Steckelberg, J. M., Hanssen, A. D., & Osmon, D. R. (2011). Management of prosthetic joint infection treated with two-stage exchange: the impact of antimicrobial therapy duration. Current Orthopaedic Practice, 22(4), 333-338. https://doi.org/10.1097/BCO.0b013e318221813a