Fully oral targeted antibiotic therapy for Gram-positive cocci-related periprosthetic joint infections: a real-life before and after study

• Published in: Journal of antimicrobial chemotherapy 2021-10, Vol.76 (11), p.3033-3036
• Main Authors: Coehlo, Alexandre, Robineau, Olivier, Titecat, Marie, Blondiaux, Nicolas, Dezeque, Hervé, Patoz, Pierre, Loiez, Caroline, Putman, Sophie, Beltrand, Eric, Migaud, Henri, Senneville, Eric
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Administration, Oral; Anti-Bacterial Agents - therapeutic use; Gram-Positive Cocci; Humans; Life Sciences; Rifampin
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkab271

Background The optimal length of the intravenous antibiotic treatment of periprosthetic joint infections (PJIs) generally ranges from one to six weeks and is a matter of debate. Most antibiotics active against Gram-positive cocci (GPC) exhibit both high oral bioavailability and bone diffusion. Thus, early oral therapy may be a reasonable option in GPC-related PJIs. Methods A 2 year before and after monocentric study that aimed to compare two antibiotic strategies. Empirical intravenous postoperative antibiotic treatment was followed by 7 to 10 days of intravenous targeted therapy (‘before’ group) or by full orally targeted antibiotic treatment (‘after’ group). The primary outcome was a treatment failure during follow-up. Results A total of 93 patients were analysed, 43 and 50 in the before and the after groups, respectively. Both groups were comparable in terms of surgical procedures, comorbidities, microbiological documentation and infection site. Antibiotics prescribed to our patients had high oral bioavailability and bone diffusion with rifampicin/fluoroquinolone combinations being the most frequent antibiotic regimens. Both hospital stay and intravenous antibiotic treatment mean durations were shorter in the before group than in the after group [15.0 versus 11.0 days; (P