Tags

Type your tag names separated by a space and hit enter

Optimization of the empirical antibiotic choice during the treatment of acute prosthetic joint infections: a retrospective analysis of 91 patients.
Acta Orthop 2019; 90(5):455-459AO

Abstract

Background and purpose - The preferred treatment of an acute prosthetic joint infection (PJI) is debridement, antibiotics, irrigation and retention of the prosthesis (DAIR). The antibiotic treatment consists of an empirical and targeted phase. In the empirical phase, intravenous antibiotics are started after surgery before micro-organisms are determined in microbiological cultures. Which empirical antibiotic is used differs between hospitals, partly reflecting geographic differences in susceptibility spectrums. We investigated whether flucloxacillin should remain the antibiotic of choice in our hospital for empiric treatment of acute PJI with DAIR. Patients and methods - We retrospectively analyzed 91 patients treated for PJI with DAIR between 2012 and 2016. The susceptibility of micro-organisms was determined in multiple cultures of periprosthetic tissue and synovial fluid for 3 antibiotics: amoxicillin/clavulanic acid, cefazolin, and flucloxacillin. Results - Positive microbiological cultures from 68 patients were analyzed. Staphylococcus aureus was the predominant pathogen, cultured in half of the patients. In one-third of patients more than 1 micro-organism was found. On a patient level, the data showed that 65% were responsive to flucloxacillin, 76% to amoxicillin/clavulanic acid, and 79% to cefazolin. Interpretation - Flucloxacillin appeared to be a suboptimal choice in our patient population treated with DAIR. We therefore changed our practice to cefazolin as the preferred antibiotic in the empirical treatment of acute PJI with DAIR.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Catharina Hospital Eindhoven , Eindhoven.Department of Orthopaedic Surgery, Catharina Hospital Eindhoven , Eindhoven.Department of Orthopaedic Surgery, Catharina Hospital Eindhoven , Eindhoven.Department of Orthopaedic Surgery, Catharina Hospital Eindhoven , Eindhoven.Orthopaedic Center Máxima, Máxima Medical Center , Eindhoven.Laboratory of Medical Microbiology, Stichting PAMM , Veldhoven , The Netherlands.Laboratory of Medical Microbiology, Stichting PAMM , Veldhoven , The Netherlands.Department of Orthopaedic Surgery, Catharina Hospital Eindhoven , Eindhoven. Orthopaedic Center Máxima, Máxima Medical Center , Eindhoven.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31132902

Citation

Van Erp, Joost H J., et al. "Optimization of the Empirical Antibiotic Choice During the Treatment of Acute Prosthetic Joint Infections: a Retrospective Analysis of 91 Patients." Acta Orthopaedica, vol. 90, no. 5, 2019, pp. 455-459.
Van Erp JHJ, Heineken AC, Van Wensen RJA, et al. Optimization of the empirical antibiotic choice during the treatment of acute prosthetic joint infections: a retrospective analysis of 91 patients. Acta Orthop. 2019;90(5):455-459.
Van Erp, J. H. J., Heineken, A. C., Van Wensen, R. J. A., Van Kempen, R. W. T. M., Hendriks, J. G. E., Wegdam-Blans, M., ... Van Der Steen, M. C. M. (2019). Optimization of the empirical antibiotic choice during the treatment of acute prosthetic joint infections: a retrospective analysis of 91 patients. Acta Orthopaedica, 90(5), pp. 455-459. doi:10.1080/17453674.2019.1621595.
Van Erp JHJ, et al. Optimization of the Empirical Antibiotic Choice During the Treatment of Acute Prosthetic Joint Infections: a Retrospective Analysis of 91 Patients. Acta Orthop. 2019;90(5):455-459. PubMed PMID: 31132902.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimization of the empirical antibiotic choice during the treatment of acute prosthetic joint infections: a retrospective analysis of 91 patients. AU - Van Erp,Joost H J, AU - Heineken,Adriaan C, AU - Van Wensen,Remco J A, AU - Van Kempen,Robin W T M, AU - Hendriks,Johannes G E, AU - Wegdam-Blans,Marjolijn, AU - Fonville,Judith M, AU - Van Der Steen,M C Marieke, Y1 - 2019/05/28/ PY - 2019/5/28/pubmed PY - 2019/5/28/medline PY - 2019/5/29/entrez SP - 455 EP - 459 JF - Acta orthopaedica JO - Acta Orthop VL - 90 IS - 5 N2 - Background and purpose - The preferred treatment of an acute prosthetic joint infection (PJI) is debridement, antibiotics, irrigation and retention of the prosthesis (DAIR). The antibiotic treatment consists of an empirical and targeted phase. In the empirical phase, intravenous antibiotics are started after surgery before micro-organisms are determined in microbiological cultures. Which empirical antibiotic is used differs between hospitals, partly reflecting geographic differences in susceptibility spectrums. We investigated whether flucloxacillin should remain the antibiotic of choice in our hospital for empiric treatment of acute PJI with DAIR. Patients and methods - We retrospectively analyzed 91 patients treated for PJI with DAIR between 2012 and 2016. The susceptibility of micro-organisms was determined in multiple cultures of periprosthetic tissue and synovial fluid for 3 antibiotics: amoxicillin/clavulanic acid, cefazolin, and flucloxacillin. Results - Positive microbiological cultures from 68 patients were analyzed. Staphylococcus aureus was the predominant pathogen, cultured in half of the patients. In one-third of patients more than 1 micro-organism was found. On a patient level, the data showed that 65% were responsive to flucloxacillin, 76% to amoxicillin/clavulanic acid, and 79% to cefazolin. Interpretation - Flucloxacillin appeared to be a suboptimal choice in our patient population treated with DAIR. We therefore changed our practice to cefazolin as the preferred antibiotic in the empirical treatment of acute PJI with DAIR. SN - 1745-3682 UR - https://www.unboundmedicine.com/medline/citation/31132902/Optimization_of_the_empirical_antibiotic_choice_during_the_treatment_of_acute_prosthetic_joint_infections:_a_retrospective_analysis_of_91_patients L2 - http://www.tandfonline.com/doi/full/10.1080/17453674.2019.1621595 DB - PRIME DP - Unbound Medicine ER -