Abstract
Introduction
After two-stage exchange due to prosthetic joint infection (PJI), the new prosthesis carries a high risk of reinfection (RePJI). There isn`t solid evidence regarding the antibiotic prophylaxis in 2nd-stage surgery. The objective of this study is to describe what antibiotic prophylaxis is used in this surgery and evaluate its impact on the risk of developing RePJI.
Methods
Retrospective multicenter case–control study in Spanish hospitals. The study included cases of PJI treated with two-stage exchange and subsequently developed a new infection. For each case, two controls were included, matched by prosthesis location, center, and year of surgery. The prophylaxis regimens were grouped based on their antibacterial spectrum, and we calculated the association between the type of regimen and the development of RePJI using conditional logistic regression, adjusted for possible confounding factors.
Results
We included 90 cases from 12 centers, which were compared with 172 controls. The most frequent causative microorganism was Staphylococcus epidermidis with 34 cases (37.8%). Staphylococci were responsible for 50 cases (55.6%), 32 of them (64%) methicillin-resistant. Gram-negative bacilli were involved in 30 cases (33.3%), the most common Pseudomonas aeruginosa. In total, 83 different antibiotic prophylaxis regimens were used in 2nd-stage surgery, the most frequent a single preoperative dose of cefazolin (48 occasions; 18.3%); however, it was most common a combination of a glycopeptide and a beta-lactam with activity against Pseudomonas spp (99 cases, 25.2%). In the adjusted analysis, regimens that included antibiotics with activity against methicillin-resistant staphylococci AND Pseudomonas spp were associated with a significantly lower risk of RePJI (adjusted OR = 0.24; 95% IC: 0.09–0.65).
Conclusions
The lack of standardization in 2nd-satge surgery prophylaxis explains the wide diversity of regimens used in this procedure. The results suggest that antibiotic prophylaxis in this surgery should include an antibiotic with activity against methicillin-resistant staphylococci and Pseudomonas.
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Data availability
The datasets generated during and/or analyzed during the current study are not publicly available due to their containing information that could compromise the privacy of research participants, but are available from the corresponding author on reasonable request.
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The study did not receive funding sources.
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JM Barbero was responsible for the organization and coordination of the study; JM Barbero, J Gómez-Junyent, L Sorlí, D Rodríguez-Pardo, O Murillo, M Fernández, R Escudero, M García, ME portillo, I Sancho, A Rico, L Guio, A Soriano, L Morata contributed with data collection; O Murillo contributed with database design. All authors contributed to the writing of the final manuscript.
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The study was approved by the local ethics committee (code EPA 22/2019).
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Conflicts of interest
JM Barbero has received honoraria for lectures from Angelini and Pfizer; D Rodríguez-Pardo has received honoraria for lectures from MSD, Tillots and Pfizer; R Escudero has received honoraria for lectures from Shiogi; F de Abajao has received grants from Foundation of Biomedical Research of the University Hospital Príncipe de Asturias; L Morata has received honoraria for lectures from Pfeizer, MSD, Angelini and Menarini; A Soriano has received honoraria for lectures from Pfeizer, MSD, Angelini and Menarini; the rest of authors declare no competing interests.
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Barbero Allende, J.M., Fernández Antón, E., Gómez-Junyent, J. et al. Impact of antibiotic prophylaxis in second-stage surgery in joint prosthesis infection treated with two-stage exchange. A multicenter case–control study. Eur J Clin Microbiol Infect Dis (2024). https://doi.org/10.1007/s10096-024-04838-3
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DOI: https://doi.org/10.1007/s10096-024-04838-3