Abstract
Objectives: Patients with prosthetic joint infections (PJIs) not suitable for curative surgery may benefit from suppressive antibiotic therapy (SAT). However, the usefulness of SAT in cases with a draining sinus has never been investigated. Methods: A multicentre, retrospective observational cohort study was performed in which patients with a PJI and a sinus tract were eligible for inclusion if managed conservatively and if sufficient follow-up data were available (i.e. at least 2 years). SAT was defined as a period of 6 months of oral antibiotic therapy. Results: SAT was initiated in 63 of 72 (87.5 %) included patients. Implant retention during follow-up was the same in patients receiving SAT vs. no SAT (79.4 % vs. 88.9 %; .68). In total, 27 % of patients using SAT experienced side effects. In addition, the occurrence of prosthetic loosening in initially fixed implants, the need for surgical debridement, or the occurrence of bacteremia during follow-up could not be fully prevented with the use of SAT, which still occurred in 42 %, 6.3 %, and 3.2 % of cases, respectively. However, the sinus tract tended to close more often (42 % vs. 13 %; .14), and a higher resolution of pain was observed (35 % vs. 14 %; .22) in patients receiving SAT. Conclusions: SAT is not able to fully prevent complications in patients with a draining sinus. However, it may be beneficial in a subset of patients, particularly in those with pain or the hindrance of a draining sinus. A future prospective study, including a higher number of patients not receiving SAT, is needed.
Highlights
Patients with a periprosthetic joint infection (PJI) require surgery in order to cure the infection
I.e. 18 years or older, PJI patients with a sinus tract were eligible for inclusion when the sinus tract was diagnosed between January 2008 and January 2018 and when they were considered ineligible for a potential curative surgical strategy or the patients themselves refused surgery
We described the outcome of a cohort of patients with a PJI and a draining sinus treated conservatively without an initial surgical intervention
Summary
Patients with a periprosthetic joint infection (PJI) require surgery in order to cure the infection. For these patients, suppressive antibiotic treatment (SAT) might be an alternative option to maintain infection control and to reduce the risk of complications (Tsukayama et al, 1991; Segreti et al, 1998; Prendki et al, 2014; Rao et al, 2003; Siqueira et al, 2015; Wouthuyzen-Bakker et al, 2017; Pradier et al, 2018; Escudero-Sanchez et al, 2020). We conducted a multicentre observational study with the aim of achieving the following outcomes: i. describing the clinical outcome of inoperable patients treated with SAT and a draining sinus ii. investigating whether the above-mentioned patients treated with SAT have a comparable clinical outcome with patients for whom SAT was withheld
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