Global practice variation of suppressive antimicrobial treatment for prosthetic joint infections: A cross-sectional survey study

Jaap L J Hanssen; Maaike G J Gademan; Marjan Wouthuyzen-Bakker; Joshua S Davis; David Dewar; Laurens Manning; David Campbell; Joffrey van Prehn; Andy O Miller; Robert J P van der Wal; Henrica M J van der Linden; Nicolás W Cortés-Penfield; Alex Soriano; Mark G J de Boer; Henk Scheper

doi:10.1016/j.jinf.2024.106316

Global practice variation of suppressive antimicrobial treatment for prosthetic joint infections: A cross-sectional survey study

J Infect. 2024 Oct 15;89(6):106316. doi: 10.1016/j.jinf.2024.106316. Online ahead of print.

Authors

Affiliations

¹ Leiden University Center for Infectious Diseases (LU-CID), Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: [email protected].
² Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
³ Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, the Netherlands.
⁴ Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
⁵ Orthopaedic department, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, NSW, Australia.
⁶ Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia; Medical School, University Western Australia, Perth, WA, Australia.
⁷ Department of Orthopaedic Surgery, Wakefield Orthopaedic Clinic, Australia; The University of Adelaide, Adelaide, SA, Australia.
⁸ Leiden University Center for Infectious Diseases (LU-CID), Medical Microbiology and Infection Control, Leiden University Medical Center, Leiden, the Netherlands.
⁹ Division of Infectious Diseases, Hospital for Special Surgery, New York, NY, USA.
¹⁰ Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
¹¹ Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA.
¹² Department of Infectious Diseases, Hospital Clínic of Barcelona, Barcelona, Spain.
¹³ Leiden University Center for Infectious Diseases (LU-CID), Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
¹⁴ Leiden University Center for Infectious Diseases (LU-CID), Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands.

PMID: 39413929
DOI: 10.1016/j.jinf.2024.106316

Abstract

Objectives: To identify global differences in the use of suppressive antimicrobial therapy (SAT) in the management of prosthetic joint infection (PJI).

Methods: An online survey was designed to investigate clinician's approach to SAT for PJI, including indications, preferred antimicrobial drugs, dosing, treatment duration and follow-up. The survey was distributed to members of four international (bone and joint) infection societies and study groups.

Results: Respondents comprised 330 physicians (204 infectious diseases specialists, 110 orthopedic surgeons, 23 clinical microbiologists) from 43 different countries (Europe, n = 134, 41%; Oceania n = 112, 34%; North America, n = 51, 16%; other, n = 33, 10%; total response rate 20%). After debridement, antibiotics and implant retention (DAIR) or one-stage revision, SAT would be initiated often or almost always by 38% of respondents from North America, but only in 6% from Europe and 7% from Oceania. First choices of SAT for staphylococcal PJI were oral cephalosporins (39%) and tetracyclines (31%) in North America; tetracyclines (27%) and anti-staphylococcal penicillins (22%) in Europe; and anti-staphylococcal penicillins (55%) in Oceania. There was no global or regional preferred SAT regimen for Gram-negative PJI. Of all respondents, dosage of SAT was never lowered (n = 126, 38%), lowered for specific antibiotics (n = 125, 38%) or lowered for all antibiotics (n = 79, 24%). SAT was prescribed for a lifelong duration (n = 43, 13%), a fixed duration (range 6 months-3 years) (n = 104, 32%) or for an undetermined duration (n = 154, 47%).

Conclusions: Approach to SAT in PJI is highly regional, with no consensus regarding the indication, selection, dose, or duration of SAT between physicians worldwide. This reflects the paucity of data and need for high quality studies to define the optimal use of SAT in the treatment of patients with PJI.

Keywords: Antimicrobial treatment; Prosthetic joint infection; Suppressive; Survey.