Aboltins Craig, Lemoh Christopher, Suleiman Mani, Soriano Alex, Davis Joshua, Manning Laurens
Department of Infectious Diseases, Northern Health, Melbourne, Victoria, Australia.
Department of Medicine, Northern Health, The University of Melbourne, Melbourne, Victoria, Australia.
Antimicrob Agents Chemother. 2025 Jun 4;69(6):e0178424. doi: 10.1128/aac.01784-24. Epub 2025 Apr 22.
The objective of this study was to describe the use of and outcomes after suppressive antimicrobial therapy (SAT) in a large prospective peri-prosthetic joint infection (PJI) cohort. SAT was defined as antimicrobial therapy continuing beyond 12 months from PJI diagnosis or where there was an early intention for SAT. The primary outcome was "treatment failure" at 24 months, defined as any of (i) clinical evidence of (ii) further surgery for or (iii) death from PJI. Secondary outcomes included quality of life (QOL) scores using Short Form 12 (SF-12) and Oxford hip (OHS) and knee (OKS) scores. SAT was prescribed for 223 of 720 (31.0%) in the cohort. Patients prescribed SAT were more likely to be older, have comorbidities, chronic PJI, higher C-reactive protein, sinus tract, or be treated with debridement and implant retention. The most frequently prescribed antimicrobials for SAT were ciprofloxacin (64 [21%]), amoxicillin (42 [14%]), and rifampicin (35 [12%]). Treatment failure was more common in the SAT group (75/185 [40.1%] vs 85/447 [19.0%]). After propensity score-adjusted analysis, SAT remained associated with higher rates of treatment failure (aOR 2.48, 95% CI [1.66-3.72]). Although 24-month QOL scores were lower in the SAT group, there were similar improvements from baseline in functional joint scores in SAT and non-SAT groups (OHS median interquartile range [IQR] +8.5 [19.0] vs +7.0 [22.0]; = 0.78 and OKS +8.0 [20.0] vs +7.0 [22.0]; = 0.53). SAT use for PJI is common, and in this study, it was not associated with improved outcomes. Identifying patients most likely to benefit from SAT should be explored in carefully designed controlled trials.
本研究的目的是描述在一个大型前瞻性人工关节周围感染（PJI）队列中抑制性抗菌治疗（SAT）的使用情况及治疗结果。SAT被定义为自PJI诊断后持续超过12个月的抗菌治疗，或早期就有进行SAT的意向。主要结局是24个月时的“治疗失败”，定义为以下任何一种情况：（i）临床证据表明；（ii）因PJI进行进一步手术；或（iii）死于PJI。次要结局包括使用简明健康调查问卷12（SF-12）的生活质量（QOL）评分以及牛津髋关节（OHS）和膝关节（OKS）评分。该队列中720例患者中有223例（31.0%）接受了SAT治疗。接受SAT治疗的患者更可能年龄较大、有合并症、患有慢性PJI、C反应蛋白水平较高、有窦道，或接受清创及保留植入物治疗。SAT最常使用的抗菌药物是环丙沙星（64例[21%]）、阿莫西林（42例[14%]）和利福平（35例[12%]）。SAT组的治疗失败更为常见（75/185[40.1%]对85/447[19.0%]）。经过倾向评分调整分析后，SAT仍然与更高的治疗失败率相关（调整后比值比2.48，95%置信区间[1.66 - 3.72]）。虽然SAT组的24个月QOL评分较低，但SAT组和非SAT组的关节功能评分从基线的改善情况相似（OHS中位数四分位间距[IQR]+8.5[19.0]对+7.0[22.0]；P = 0.78；OKS +8.0[20.0]对+7.0[22.0]；P = 0.53）。PJI使用SAT很常见，而在本研究中，它与改善治疗结果无关。应在精心设计的对照试验中探索确定最可能从SAT中获益的患者。
