254. Excellent Outcomes with Oral Versus Intravenous Antibiotics for Bone and Joint Infections: A Single-Center Experience

Abstract

Abstract Background The OVIVA trial, published in 2019, demonstrated equivalent efficacy of oral (PO) versus intravenous (IV) antibiotics for bone and joint infections. We report our group’s one-year outcomes in a cohort of such patients who received PO or IV antibiotics. Methods Our orthopedic surgery and orthopedic infectious diseases (ID) groups agreed to employ early switch to PO in patients with a first episode of non-vertebral osteomyelitis (OM), native or prosthetic joint infection (NJA or PJI), or hardware infections when a pathogen susceptible to highly bioavailable antibiotics had been identified and the patient was perceived to be at low risk for medication non-adherence. We reviewed patients 19+ years old seen in the Ortho ID clinic for one of these conditions from July 1st through December 31st, 2019. Data recorded included patient demographics and comorbidities, infection type and site, microbiology, and surgical and antibiotic management. Primary outcome was treatment failure at 1 year, defined as death, unplanned surgery at same site, or chronic antibiotic suppression. Results Forty patients (all IV antibiotics, n=17; initial or switch to PO, n=23) were included. Median IV duration was 15 days. PJI was the most common diagnosis (n=22), followed by other hardware infection and OM (n=7 each). Of the PJIs, 13/22 were managed with 2-stage exchange and 11/13 of these received all-IV therapy. Of the hardware infections, 4/7 underwent debridement and retention or single-stage exchange and all of these received initial or switch to PO therapy. Staphylococci (n=14 S. aureus and n=7 coagulase-negative) and streptococci (n=12) were the most common pathogens. Amoxicillin (n=8), trimethoprim-sulfa (n=6), and levofloxacin (n=3) were the most-used PO antibiotics. The PO group received longer treatment (mean 67 vs 48 days). No treatment failures occurred in the patients who started or switch to PO antibiotics, whereas 35% of patients who received all-IV therapy experienced failure. Conclusion Adopting known risk factors for poor outcome in bone and joint infection such as prior treatment failure and no identified pathogen as exclusion criteria for early switch to PO antibiotic therapy led to excellent one-year treatment outcomes across a range of musculoskeletal infections. Disclosures Angela Hewlett, MD, MS, Mapp Biopharmaceutical (Scientific Research Study Investigator) Angela Hewlett, MD, MS, Mapp Biopharmaceutical, Inc (Individual(s) Involved: Self): Scientific Research Study Investigator Nicolas W. Cortes-Penfield, MD, Nothing to disclose