Abstract
Purpose: To compare safety and efficacy of Vancomycin (Van) versus Daptomycin (Dap) as post-operative empirical antibiotic treatment (PEAT) in patients with periprosthetic joint infections (PJIs).Methods: Medical charts of patients treated empirically with Van or Dap in the post-operative period of total hip/knee prosthesis septic revision until the results of intra-operative culture were reviewed. Cefotaxime, cefepime or aztreonam were used in combination with Dap or Van.Results: Twenty Dap patients were matched with 20 other Van patients according to the age and type of prosthesis. The ASA score and the distribution of the pathogens was similar in the two groups especially regarding the number of methicillin-resistant staphylococci. The mean duration of the PEAT was 6.07 ± 0.85 days. A total of 17 episodes of adverse events (AE) in 10 patients (25%) were recorded during the PEAT which led to discontinue the treatment in 5 patients, all of them treated with Van (P=0.02). At the end of a mean post-treatment follow-up of 618 +/- 219 days, 36 patients remained in remission of infection; 2 patients failed in each group.Conclusions: Our observations suggest that PEAT with Van for septic revision of PJIs is associated with a higher discontinuation rate due to AE but with a similar outcome than it is with Dap.
Highlights
Periprosthetic joint infections (PJIs) are treated in most cases by debridement, antibiotic therapy and implant retention (DAIR) or replacement in one or two-stage of the infected implants [1]
Given the important role of staphylococci in PJIs it seems important that the per-operative empirical antibiotic therapy (PEAT) would cover these pathogens including methicillin-resistant (MR) strains while waiting for the culture results of the intraoperative samples [2]
From 01-2008 to 03-2012, Van was used as the first-line antibiotic agent in combination with a broad-spectrum β-lactam agent for PEAT in patients who underwent a septic revision for a PJI
Summary
Periprosthetic joint infections (PJIs) are treated in most cases by debridement, antibiotic therapy and implant retention (DAIR) or replacement in one or two-stage of the infected implants [1]. Given the important role of staphylococci in PJIs it seems important that the per-operative empirical antibiotic therapy (PEAT) would cover these pathogens including methicillin-resistant (MR) strains while waiting for the culture results of the intraoperative samples [2]. Vancomycin (Van) is used as part of the PEAT in patients with PJI operated for DAIR and one/twohttp://www.jbji.net step exchange [2]. Dap is more effective than Van for the treatment of experimental foreign-body and systemic infections by biofilm-producing methicillin-resistant S. epidermidis [4,5]. The potential caveats of Dap are its cost and the selection of bacterial resistance
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