Department of Pharmacy, Mayo Clinic Hospital, Rochester, Minnesota, USA.
Division of Infectious Diseases, Mayo Clinic Hospital, Rochester, Minnesota, USA.
Clin Infect Dis. 2021 Sep 7;73(5):850-856. doi: 10.1093/cid/ciab145.
Fluoroquinolones (FQs) are known to be accompanied by significant risks. However, the incidence of adverse events (ADEs) resulting in unplanned drug discontinuation when used for periprosthetic joint infections (PJIs) is currently unknown.
This study included 156 patients over the age of 18 treated for staphylococcal PJI with debridement, antibiotics, and implant retention between 1 January 2007 and 21 November 2019. Of the 156 patients, 64 had total hip arthroplasty (THA) and 92 had total knee arthroplasty (TKA) infections. The primary outcome was rate of unplanned drug discontinuation. Secondary outcomes included incidence of severe ADEs, unplanned rifamycin discontinuation, mean time to unplanned regimen discontinuation, and all-cause mortality.
Overall, unplanned drug discontinuation occurred in 35.6% of patients in the FQ group and 3% of patients in the non-FQ group. The rate of unplanned discontinuation of FQ regimens as compared with non-FQ regimens was 27.5% vs 4.2% (P = .021) in THA infections and 42% vs 2.4% (P < .001) in TKA infections. There was no significant difference in severe ADEs between FQ and non-FQ regimens in both THA and TKA infections. The overall rate of nonsevere ADEs in FQ compared with non-FQ regimens was 43.3% vs 6.1% (P < .001). FQs were associated with tendinopathy, myalgia, arthralgia, and nausea.
A significantly higher rate of unplanned drug discontinuation was associated with FQ as compared with non-FQ regimens. This provides a real-world view of the implications of FQ-related ADEs on unplanned discontinuation when used in prolonged durations for the management of staphylococcal PJIs.
氟喹诺酮类药物（FQs）已知存在重大风险。然而，目前尚不清楚在用于假体周围关节感染（PJIs）时，导致计划外药物停药的不良事件（ADEs）的发生率。
本研究纳入了 2007 年 1 月 1 日至 2019 年 11 月 21 日期间，156 名年龄在 18 岁以上的葡萄球菌 PJI 患者，接受清创术、抗生素和保留植入物治疗。156 名患者中，64 例为全髋关节置换术（THA），92 例为全膝关节置换术（TKA）感染。主要结局为计划外药物停药率。次要结局包括严重 ADEs 的发生率、计划外利福霉素停药、计划外方案停药的平均时间以及全因死亡率。
总体而言，FQ 组 35.6%的患者和非 FQ 组 3%的患者出现计划外药物停药。THA 感染中，FQ 方案与非 FQ 方案相比，计划外停药率分别为 27.5%和 4.2%（P=0.021），TKA 感染中，计划外停药率分别为 42%和 2.4%（P<0.001）。THA 和 TKA 感染中，FQ 和非 FQ 方案的严重 ADEs 发生率无显著差异。FQ 与非 FQ 方案相比，非严重 ADEs 的总体发生率分别为 43.3%和 6.1%（P<0.001）。FQ 与肌腱病、肌痛、关节痛和恶心有关。
与非 FQ 方案相比，FQ 方案计划外停药率显著更高。这提供了 FQ 相关 ADEs 对用于治疗葡萄球菌 PJI 的延长时间内计划外停药的影响的真实世界观点。
