Abstract
BackgroundThe optimal duration of intravenous antibiotic therapy in Staphylococcus aureus prosthetic bone and joint infection has not been established. The objective of this study was to compare the effect of early and late intravenous-to-oral antibiotic switch on treatment failure.Patients and methodsWe retrospectively analyzed all adult cases of S. aureus prosthetic bone and joint or orthopedic metalware-associated infection between January 2008 and December 2015 in a French university hospital. The primary outcome was treatment failure defined as the recurrence of S. aureus prosthetic bone and joint or orthopedic metalware-associated infection at any time during or after the first line of medical and surgical treatment within 2 years of follow-up. A Cox model was created to assess risk factors for treatment failure.ResultsAmong the 140 patients included, mean age was 60.4 years (SD 20.2), and 66% were male (n = 92). Most infections were due to methicillin-susceptible S. aureus (n = 113, 81%). The mean duration of intravenous antibiotic treatment was 4.1 days (SD 4.6). The majority of patients (119, 85%) had ≤5 days of intravenous therapy. Twelve patients (8.5%) experienced treatment failure. Methicillin-resistant S. aureus infections (HR 11.1; 95% CI 1.5–111.1; p = 0.02), obesity (BMI > 30 kg/m2) (HR 6.9; 95% CI1.4–34.4, p = 0.02) and non-conventional empiric antibiotic therapy (HR 7.1; 95% CI 1.8–25.2; p = 0.005) were significantly associated with treatment failure, whereas duration of intravenous antibiotic therapy (≤ 5 or > 5 days) was not.ConclusionThere was a low treatment failure rate in patients with S. aureus prosthetic bone and joint or orthopedic metalware-associated infection with early oral switch from intravenous to oral antibiotic therapy.
Highlights
Despite considerable progress on their prevention, prosthetic bone and joint or orthopedic metalwareassociated infections remain a major public health problem in terms of cost, morbidity and mortality [1, 2]
Most infections were due to methicillin-susceptible S. aureus (n = 113, 81%)
Methicillin-resistant S. aureus infections (HR 11.1; 95% confidence intervals (CIs) 1.5–111.1; p = 0.02), obesity (BMI > 30 kg/m2) (HR 6.9; 95% CI1.4–34.4, p = 0.02) and non-conventional empiric antibiotic therapy (HR 7.1; 95% CI 1.8–25.2; p = 0.005) were significantly associated with treatment failure, whereas duration of intravenous antibiotic therapy (≤ 5 or > 5 days) was not
Summary
Despite considerable progress on their prevention, prosthetic bone and joint or orthopedic metalwareassociated infections remain a major public health problem in terms of cost, morbidity and mortality [1, 2]. The Infectious Diseases Society of America (IDSA) recommends that S. aureus infections are treated, regardless of the surgical intervention, with 2 to 6 weeks (6 weeks if rifampicin is not possible) of intravenous antistaphylococcal antibiotic therapy combined with oral rifampicin followed by oral antibiotic therapy for 3 to 6 months, depending on the affected joint [4]. The French Infectious Diseases Society (SPILF) [5] recommends 2 weeks of intravenous treatment and a total duration of 6 to 12 weeks, but acknowledges that the duration of parenteral antibiotic therapy has not been validated, and proposes an earlier oral switch if possible, according to “expert opinion”. The optimal duration of intravenous antibiotic therapy in Staphylococcus aureus prosthetic bone and joint infection has not been established. The objective of this study was to compare the effect of early and late intravenous-to-oral antibiotic switch on treatment failure
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