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. 2024 Dec;89(6):106316.
doi: 10.1016/j.jinf.2024.106316. Epub 2024 Oct 15.

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

Jaap L J Hanssen  1 , Maaike G J Gademan  2 , Marjan Wouthuyzen-Bakker  3 , Joshua S Davis  4 , David Dewar  5 , Laurens Manning  6 , David Campbell  7 , Joffrey van Prehn  8 , Andy O Miller  9 , Robert J P van der Wal  10 , Henrica M J van der Linden  10 , Nicolás W Cortés-Penfield  11 , Alex Soriano  12 , Mark G J de Boer  13 , Henk Scheper  14
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Free article

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

Jaap L J Hanssen et al. J Infect. 2024 Dec.
Free article

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.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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