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

: 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. : All patients with OII treated with SA...

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Bibliographic Details
Published in:Journal of bone and joint infection 2024-06, Vol.9 (3), p.149-159
Main Authors: Hanssen, Jaap L J, van der Wal, Robert J P, van der Linden, Henrica M J, van Prehn, Joffrey, Scheper, Henk, de Boer, Mark G J
Format: Article
Language:English
Subjects:
Analysis
Care and treatment
Health aspects
Implants, Artificial
Infection
Medical research
Medicine, Experimental
Prosthesis
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Summary:: 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. : 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. : 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 ( ) 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. : 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.
ISSN:2206-3552
2206-3552
DOI:10.5194/jbji-9-149-2024