Abstract
Introduction: A post-operative empirical antibiotic therapy (PEAT) is required in periprosthetic joint infections. It commonly uses broad-spectrum antibiotics to cover most Gram-positive cocci and Gram-negative bacilli. It is currently continued until first microbiological results are available, no less than five days later.Methods: We performed a retrospective study in order to evaluate duration of incubation required for surgical samples using the BacT/Alert® Virtuo blood culture bottles system.Results: Among 216 surgical interventions and 199 clinical strains (53.8% staphylococci, 22,1% streptococci and enterococci, 14,6% Gram-negative bacilli, 5,5% anaerobes), 90.5% of the strains were detected between day 0 and day 2; 15 infective strains are cultured from day 3 including 8 Cutibacterium sp., 4 staphylococci, 2 streptococci and 1 Enterococcus.Conclusions: We suggest that the duration of PEAT in patients operated for a periprosthetic joint infection may be shortened to three days as Gram-negative rods are unlikely to grow after three days of culture by using BacT/Alert® Virtuo blood culture bottles. This is likely to shorten the overall length of hospital stay, to diminish the occurrence of adverse side effects, and the emergence of antimicrobial resistance. However, coverage of Gram-positive cocci should be maintained for 14 days until the definite culture results are available.
Highlights
A post-operative empirical antibiotic therapy (PEAT) is required in periprosthetic joint infections
Periprosthetic joint infections (PJIs) require both surgical intervention and prolonged course of intravenous and oral antibiotic therapy conducted in light of the most recent guidelines for the management of these potentially life-threatening infections [1,2]
Until the results of intraoperative sample cultures are available, an initial broad-spectrum post-operative empirical antibiotic therapy (PEAT) is needed in order to prevent the colonization of newly implants or the prosthesis that has been cleaned but not removed during the socalled debridement antibiotic and implant retention (DAIR) intervention
Summary
A post-operative empirical antibiotic therapy (PEAT) is required in periprosthetic joint infections. It commonly uses broad-spectrum antibiotics to cover most Gram-positive cocci and Gram-negative bacilli. It is currently continued until first microbiological results are available, no less than five days later. Until the results of intraoperative sample cultures are available, an initial broad-spectrum post-operative empirical antibiotic therapy (PEAT) is needed in order to prevent the colonization of newly implants or the prosthesis that has been cleaned but not removed during the socalled debridement antibiotic and implant retention (DAIR) intervention. Delayed adequate antibiotic treatment of PJI is associated with worse outcomes [2,3]
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