How We Approach Suppressive Antibiotic Therapy Following Debridement, Antibiotics, and Implant Retention for Prosthetic Joint Infection

Nicolas Cortes-Penfield, Martin Krsak, Laura Damioli, Michael Henry, Jessica Seidelman, Angela Hewlett, Laura Certain

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations

Abstract

The optimal treatment of prosthetic joint infection (PJI) remains uncertain. Patients undergoing debridement, antibiotics, and implant retention (DAIR) receive extended antimicrobial treatment, and some experts leave patients at perceived highest risk of relapse on suppressive antibiotic therapy (SAT). In this narrative review, we synthesize the literature concerning the role of SAT to prevent treatment failure following DAIR, attempting to answer 3 key questions: (1) What factors identify patients at highest risk for treatment failure after DAIR (ie, patients with the greatest potential to benefit from SAT), (2) Does SAT reduce the rate of treatment failure after DAIR, and (3) What are the rates of treatment failure and adverse events necessitating treatment discontinuation in patients receiving SAT? We conclude by proposing risk–benefit stratification criteria to guide use of SAT after DAIR for PJI, informed by the limited available literature.

Original languageEnglish (US)
Pages (from-to)188-198
Number of pages11
JournalClinical Infectious Diseases
Volume78
Issue number1
DOIs
StatePublished - Jan 15 2024

Keywords

  • DAIR
  • PJI
  • antibiotic suppression
  • prosthetic joint infection
  • suppressive antibiotic therapy

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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