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322. Joint Spacer Retention, Antimicrobial Suppression, and Risk of Re-infection
BACKGROUND: Two-stage exchange is the standard treatment of periprosthetic joint infection in the United States. Occasionally, for selected patients, temporary antibiotic-loaded spacers are retained “permanently” instead of proceeding with prosthesis re-implantation. It is unclear whether the “retai...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255013/ http://dx.doi.org/10.1093/ofid/ofy210.333 |
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author | Valencia, Jose Carlo Osmon, Douglas Abdel, Matthew Razonable, Raymund R |
author_facet | Valencia, Jose Carlo Osmon, Douglas Abdel, Matthew Razonable, Raymund R |
author_sort | Valencia, Jose Carlo |
collection | PubMed |
description | BACKGROUND: Two-stage exchange is the standard treatment of periprosthetic joint infection in the United States. Occasionally, for selected patients, temporary antibiotic-loaded spacers are retained “permanently” instead of proceeding with prosthesis re-implantation. It is unclear whether the “retained” spacer represents a nidus for re-infection, and would require secondary antibiotic suppression to prevent recurrence of infection. We aim to determine the risk of re-infection among patients with retained knee and hip spacers, and assess the role of antibiotic suppression. METHODS: We identified 51 patients with retained static or articulating knee (n = 34) and hip (n = 17) spacers between 1996 and 2014 using the Mayo Clinic Hospital Orthopedic database. Medical records were reviewed to collect clinical data, including antibiotic use and offending organisms. We compared the cumulative incidence of reinfection between those with or without suppression using a competing risk model, with death and revision for mechanical failure as competing risks. RESULTS: The median age was 77 years (range, 48–94). Gender distribution was equal. The median Charlton Comorbidity Index (CCI) was 3 (1–11), while median BMI was 30.1 (17.8–59.5). Eleven of 51 patients received antibiotic suppression after spacer retention. A history of prior antibiotic suppressive therapy was the only variable associated with being placed back on antibiotic suppression after spacer retention [OR 18 (95% CI 3.2–100)]. During the median follow-up period of 31.3 months, there were five re-infections. The cumulative incidence of re-infection was not significantly different between suppressed and unsuppressed groups (P = 0.89). The re-infecting pathogens were different from the index offending organisms. Only the presence of preoperative draining sinus was significantly associated with re-infection [OR 10 (95% CI 1–99.6)]. CONCLUSION: In selected patients where a second-stage prosthesis re-implantation is not an option, and retention of “temporary” antibiotic loaded spacer is surgically preferred, the risk of re-infection was not prevented by prolonged antibiotic suppression. The presence of a draining sinus was significantly associated with re-infection, often with new pathogens. DISCLOSURES: All authors: No reported disclosures. |
format | Online Article Text |
id | pubmed-6255013 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-62550132018-11-28 322. Joint Spacer Retention, Antimicrobial Suppression, and Risk of Re-infection Valencia, Jose Carlo Osmon, Douglas Abdel, Matthew Razonable, Raymund R Open Forum Infect Dis Abstracts BACKGROUND: Two-stage exchange is the standard treatment of periprosthetic joint infection in the United States. Occasionally, for selected patients, temporary antibiotic-loaded spacers are retained “permanently” instead of proceeding with prosthesis re-implantation. It is unclear whether the “retained” spacer represents a nidus for re-infection, and would require secondary antibiotic suppression to prevent recurrence of infection. We aim to determine the risk of re-infection among patients with retained knee and hip spacers, and assess the role of antibiotic suppression. METHODS: We identified 51 patients with retained static or articulating knee (n = 34) and hip (n = 17) spacers between 1996 and 2014 using the Mayo Clinic Hospital Orthopedic database. Medical records were reviewed to collect clinical data, including antibiotic use and offending organisms. We compared the cumulative incidence of reinfection between those with or without suppression using a competing risk model, with death and revision for mechanical failure as competing risks. RESULTS: The median age was 77 years (range, 48–94). Gender distribution was equal. The median Charlton Comorbidity Index (CCI) was 3 (1–11), while median BMI was 30.1 (17.8–59.5). Eleven of 51 patients received antibiotic suppression after spacer retention. A history of prior antibiotic suppressive therapy was the only variable associated with being placed back on antibiotic suppression after spacer retention [OR 18 (95% CI 3.2–100)]. During the median follow-up period of 31.3 months, there were five re-infections. The cumulative incidence of re-infection was not significantly different between suppressed and unsuppressed groups (P = 0.89). The re-infecting pathogens were different from the index offending organisms. Only the presence of preoperative draining sinus was significantly associated with re-infection [OR 10 (95% CI 1–99.6)]. CONCLUSION: In selected patients where a second-stage prosthesis re-implantation is not an option, and retention of “temporary” antibiotic loaded spacer is surgically preferred, the risk of re-infection was not prevented by prolonged antibiotic suppression. The presence of a draining sinus was significantly associated with re-infection, often with new pathogens. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6255013/ http://dx.doi.org/10.1093/ofid/ofy210.333 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Valencia, Jose Carlo Osmon, Douglas Abdel, Matthew Razonable, Raymund R 322. Joint Spacer Retention, Antimicrobial Suppression, and Risk of Re-infection |
title | 322. Joint Spacer Retention, Antimicrobial Suppression, and Risk of Re-infection |
title_full | 322. Joint Spacer Retention, Antimicrobial Suppression, and Risk of Re-infection |
title_fullStr | 322. Joint Spacer Retention, Antimicrobial Suppression, and Risk of Re-infection |
title_full_unstemmed | 322. Joint Spacer Retention, Antimicrobial Suppression, and Risk of Re-infection |
title_short | 322. Joint Spacer Retention, Antimicrobial Suppression, and Risk of Re-infection |
title_sort | 322. joint spacer retention, antimicrobial suppression, and risk of re-infection |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255013/ http://dx.doi.org/10.1093/ofid/ofy210.333 |
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