Dosing and treatment duration of suppressive antimicrobial therapy in orthopedic implant infections: a cohort study.

Autor:	Hanssen JLJ; Leiden University Center for Infectious Diseases (LU-CID), Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands., van der Wal RJP; Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands., van der Linden HMJ; Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands., van Prehn J; Leiden University Center for Infectious Diseases (LU-CID), Medical Microbiology and Infection Control, Leiden University Medical Center, Leiden, the Netherlands., Scheper H; Leiden University Center for Infectious Diseases (LU-CID), Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands., de Boer MGJ; Leiden University Center for Infectious Diseases (LU-CID), Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands.; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
Jazyk:	angličtina
Zdroj:	Journal of bone and joint infection [J Bone Jt Infect] 2024 Jun 04; Vol. 9 (3), pp. 149-159. Date of Electronic Publication: 2024 Jun 04 (Print Publication: 2024).
DOI:	10.5194/jbji-9-149-2024
Abstrakt:	Introduction : Limited data inform about the optimal dosing and duration of suppressive antimicrobial therapy (SAT) for orthopedic implant infection (OII). We aimed to compare the effectiveness of low-dosage with standard-dosage SAT and evaluate the safety of stopping SAT. Methods : All patients with OII treated with SAT from 2011 to 2022 were retrospectively included. Data were extracted from electronic patient files. Low-dosage SAT was defined as antimicrobial therapy dosed lower than the standard dosage recommended for OII. The association of dosing strategy and other factors with failure-free survival were assessed by Kaplan-Meier and Cox proportional hazard models. Results : One-hundred-and-eight patients were included. The median follow-up time after SAT initiation was 21 months (interquartile range (IQR) 10-42 months). SAT was successful in 74 patients (69 %). Low-dosage SAT ( n = 82 ) was not associated with failure in univariate (hazard ratio (HR) 1.23, 95 % confidence interval (CI) 0.53-2.83) and multivariate analyses (HR 1.24, 95 % CI 0.54-2.90). In 25 patients (23 %), SAT was stopped after a median treatment duration of 26 months. In this group, one patient (4 %) developed a relapse. Conclusions : In this study, low-dosage SAT was as effective as standard dosage SAT. Moreover, stopping SAT after 2 to 3 years may be justified in patients with a good clinical course. These findings warrant further research on optimal dosing and duration of SAT and on the durability of in vivo biofilms. Competing Interests: The contact author has declared that none of the authors has any competing interests. (Copyright: © 2024 Jaap L. J. Hanssen et al.)
Databáze:	MEDLINE
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