TY - JOUR
T1 - Global practice variation of suppressive antimicrobial treatment for prosthetic joint infections
T2 - A cross-sectional survey study
AU - Hanssen, Jaap L.J.
AU - Gademan, Maaike G.J.
AU - Wouthuyzen-Bakker, Marjan
AU - Davis, Joshua S.
AU - Dewar, David
AU - Manning, Laurens
AU - Campbell, David
AU - van Prehn, Joffrey
AU - Miller, Andy O.
AU - van der Wal, Robert J.P.
AU - van der Linden, Henrica M.J.
AU - Cortés-Penfield, Nicolás W.
AU - Soriano, Alex
AU - de Boer, Mark G.J.
AU - Scheper, Henk
N1 - Publisher Copyright:
© 2024 The Author(s)
PY - 2024/12
Y1 - 2024/12
N2 - 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.
AB - 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.
KW - Antimicrobial treatment
KW - Prosthetic joint infection
KW - Suppressive
KW - Survey
UR - http://www.scopus.com/inward/record.url?scp=85206668676&partnerID=8YFLogxK
U2 - 10.1016/j.jinf.2024.106316
DO - 10.1016/j.jinf.2024.106316
M3 - Article
C2 - 39413929
AN - SCOPUS:85206668676
SN - 0163-4453
VL - 89
JO - Journal of infection
JF - Journal of infection
IS - 6
M1 - 106316
ER -