The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections.

Deroche Deroche,Corvec Corvec,Valentin Valentin,Jolivet-Gougeon Jolivet-Gougeon,Kempf Kempf,Bémer Bémer,Lemarié Lemarié,Tandé Tandé,Héry-Arnaud Héry-Arnaud,Plouzeau Plouzeau,Burucoa Burucoa,Bret Bret

doi:10.3390/jcm8122113

Abstract

Currently, no guideline provides recommendations on the duration of empirical antimicrobial treatment (EAT) in prosthetic joint infection (PJI). The aim of our study was to describe the time to growth of bacteria involved in PJI, rendering possible decreased duration of EAT. Based on a French multicentre prospective cohort study, culture data from patients with confirmed hip or knee PJI were analysed. For each patient, five samples were processed. Time to positivity was defined as the first positive medium in at least one sample for virulent pathogens and as the first positive medium in at least two samples for commensals. Definitive diagnosis of polymicrobial infections was considered the day the last bacteria were identified. Among the 183 PJIs, including 28 polymicrobial infections, microbiological diagnosis was carried out between Day 1 (D1) and D5 for 96.7% of cases. There was no difference in the average time to positivity between acute and chronic PJI (p = 0.8871). Microbiological diagnosis was given earlier for monomicrobial than for polymicrobial infections (p = 0.0034). When an optimized culture of peroperative samples was carried out, almost all cases of PJI were diagnosed within five days, including polymicrobial infections. EAT can be re-evaluated at D5 according to microbiological documentation.

Highlights

The management of prosthetic joint infection (PJI) is a major challenge for physicians, as its consequences can be devastating for the patient
An empirical antimicrobial treatment (EAT) with antibiotics is settled after surgery in order to cover the bacteria most frequently isolated from PJI
No significant difference was observed between the clinical features of monomicrobial and polymicrobial infection groups

Summary

Introduction

The management of prosthetic joint infection (PJI) is a major challenge for physicians, as its consequences can be devastating for the patient. An empirical antimicrobial treatment (EAT) with antibiotics is settled after surgery in order to cover the bacteria most frequently isolated from PJI. A combination containing a beta-lactam, such as piperacillin/tazobactam or a third-generation cephalosporin, is recommended, associated to an antibiotic that has been shown to be effective against Gram-positive bacteria, methicillin-resistant staphylococci in particular [2,3,4,5]. The probabilistic antibiotics often used are not harmless, and severe adverse effects can occur, such as nephrotoxicity when the vancomycin being used is associated with piperacillin/tazobactam [10,11]. The goal of the present study was to describe the growth time of bacteria involved in hip or knee PJI in order to find out when EAT can be safely re-evaluated, according to microbiological results

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Discussion

Conclusion