Chao Richard, Rothenberger Scott D, Frear Andrew J, Hamlin Brian R, Klatt Brian A, Shah Neel B, Urish Kenneth L
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Center for Research on Health Care Data Center, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
J Arthroplasty. 2025 Sep;40(9S1):S528-S534. doi: 10.1016/j.arth.2024.10.061. Epub 2024 Nov 13.
Periprosthetic joint infections (PJIs) are common and serious complications following knee and hip arthroplasty. Our previous retrospective study suggested extended antibiotics following debridement, antibiotics, and implant retention (DAIR) decreased failure rates and were not associated with increased adverse events (AEs) as compared to a standard 6 weeks of antibiotic therapy. Further, extended antibiotics beyond one year did not provide additional benefits. These observations were tested in this prospective cohort study.
A prospective cohort of patients who underwent DAIR for total knee arthroplasty PJI and received primary antibiotics were compared to patients who received primary antibiotics combined with extended antibiotics for one year. Participants had a minimum of 2-year follow-up after the final dose of antibiotics.
A prospective cohort of 79 patients was followed, where 39 participants (52.7%) received primary antibiotics and 35 participants (47.3%) received both primary and extended antibiotics following DAIR. Multivariable time-to-event analyses revealed that extended antibiotic use was an independent predictor of treatment success. Infection-free survival differed significantly between the two treatment regimens, as the hazard of PJI failure was significantly lower for extended antibiotics as compared to primary antibiotics alone (adjusted hazard ratio [HR] = 0.46 [0.24 to 0.87], P = 0.017). The AE rates did not significantly differ between patients treated with primary antibiotics only versus primary combined with extended antibiotics.
This prospective cohort study supports our previous observations that extended antibiotics for one year were associated with lower failure rates as compared to primary antibiotics alone. Extended antibiotics after primary antibiotics were not found to be associated with increased AEs as compared to only primary antibiotics.
人工关节周围感染（PJI）是膝关节和髋关节置换术后常见且严重的并发症。我们之前的回顾性研究表明，与标准的6周抗生素治疗相比，清创、抗生素及植入物保留（DAIR）术后延长抗生素使用时间可降低失败率，且与不良事件（AE）增加无关。此外，超过一年的延长抗生素治疗并未带来额外益处。这些观察结果在本前瞻性队列研究中进行了验证。
将接受DAIR治疗全膝关节置换术PJI并接受初始抗生素治疗的患者前瞻性队列与接受初始抗生素联合延长抗生素治疗一年的患者进行比较。参与者在最后一剂抗生素后至少随访2年。
对79例患者的前瞻性队列进行了随访，其中39例参与者（52.7%）接受初始抗生素治疗，35例参与者（47.3%）在DAIR术后接受初始抗生素和延长抗生素治疗。多变量事件发生时间分析显示，延长抗生素使用是治疗成功的独立预测因素。两种治疗方案的无感染生存率存在显著差异，因为与单独使用初始抗生素相比，延长抗生素治疗的PJI失败风险显著更低（调整后的风险比[HR]=0.46[0.24至0.87]，P=0.017）。仅接受初始抗生素治疗的患者与接受初始抗生素联合延长抗生素治疗的患者之间的AE发生率无显著差异。
这项前瞻性队列研究支持了我们之前的观察结果，即与单独使用初始抗生素相比，延长抗生素治疗一年与更低的失败率相关。与仅使用初始抗生素相比，初始抗生素后使用延长抗生素未发现与AE增加相关。
