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Combined antibiotic therapy spacers either commercial or handmade are superior to monotherapy – a microbiological analysis at the second stage of revision

2021-08Journal article Open access
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dc.contributor.authorDias Carvalho, Andre
dc.contributor.authorRibau, Ana
dc.contributor.authorSoares, Daniel
dc.contributor.authorSantos, Ana Claudia
dc.contributor.authorAbreu, Miguel
dc.contributor.authorSousa, Ricardo
dc.date.accessioned2024-01-30T12:02:30Z
dc.date.available2024-01-30T12:02:30Z
dc.date.issued2021-08
dc.description.abstractBackground: Antibiotic-loaded spacers are often used during two-stage exchange for periprosthetic joint infections (PJIs) both for its mechanical properties and as a means of local antibiotic delivery. Purpose: The main goal of this study is to compare the efficacy of different options of antibiotic(s) in spacers concerning the rate of positive cultures at the second stage. Patients and Methods: We retrospectively evaluated two-stage exchange procedures for infected hip or knee arthroplasty performed between 2012 and 2018 in which adequate (at least four deep tissue samples) culture results in both stages were available. The type of spacer and antibiotics used, in addition to several other patient, infection and treatment-related variables, were registered and correlated to microbiological findings in the second stage. Results: Fifty-eight cases were included with a 19.0 % (11/58) overall rate of positive cultures during reimplantation. With a mean follow-up of 46 months, failure rate was significantly higher at 63.6 % (7/11) in cases with positive cultures at reimplantation compared to 4.3 % (2/47) for those with negative cultures during reimplantation ( p < 0.001). The need for additional surgeries was also significantly higher (odds ratio (OR) 122.67, confidence interval (CI) 95 % 11.30-1331.32, p < 0.001). Multivariable analysis revealed antibiotics in the spacers were the main independent prognostic risk factor associated with positive cultures at the second stage with an advantage for combined antibiotics. Monotherapy is associated with failure with an OR of 16.99. Longer time between surgeries did not have statistical significance ( p = 0.05), and previous surgical treatment for PJI, presence of difficult-to-treat microorganism(s), duration of systemic antibiotic therapy or even treatment within a dedicated septic team were not shown to be independent risk factors. Among combined antibiotic spacers, there were no significant differences between the rate of positive cultures during the second stage, comparing commercially available vancomycin/gentamicin spacers to hand-mixed vancomycin/meropenem manufactured spacers (8.3 % [2/24] vs. 15.0 % [3/20], p = 0.68). Conclusions: Results show that combined antibiotic therapy spacers are advantageous when compared to gentamicin monotherapy as they produce significantly lower rates of subsequent positive cultures during the second stage. Hand-mixed high-dose vancomycin/meropenem spacers seem to perform just as well as prefabricated commercially available vancomycin/gentamicin options. Level of Evidence: Therapeutic level III.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationDias Carvalho A, Ribau A, Soares D, Santos AC, Abreu M, Sousa R. Combined antibiotic therapy spacers either commercial or handmade are superior to monotherapy - a microbiological analysis at the second stage of revision. J Bone Jt Infect. 2021;6(7):305-312. doi:10.5194/jbji-6-305-2021pt_PT
dc.identifier.doi10.5194/jbji-6-305-2021pt_PT
dc.identifier.issn2206-3552
dc.identifier.urihttp://hdl.handle.net/10400.16/2903
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherCopernicus Publicationspt_PT
dc.relation.publisherversionhttps://jbji.copernicus.org/articles/6/305/2021/pt_PT
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/pt_PT
dc.titleCombined antibiotic therapy spacers either commercial or handmade are superior to monotherapy – a microbiological analysis at the second stage of revisionpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlaceGermanypt_PT
oaire.citation.endPage312pt_PT
oaire.citation.issue7pt_PT
oaire.citation.startPage305pt_PT
oaire.citation.titleJournal of Bone and Joint Infectionpt_PT
oaire.citation.volume6pt_PT
person.familyNameDias Carvalho
person.familyNameCosta Ribau
person.familyNameVieira Braga de Araújo Abreu
person.familyNameSousa
person.givenNameAndre
person.givenNameAna Isabel
person.givenNameMiguel
person.givenNameRicardo
person.identifier.ciencia-id5812-146E-1715
person.identifier.ciencia-id8C18-816F-6E4A
person.identifier.orcid0000-0002-3741-849X
person.identifier.orcid0000-0002-6087-942X
person.identifier.orcid0000-0001-6999-6641
person.identifier.orcid0000-0003-4293-7347
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication89459d31-c892-40f1-9753-9a09c76fa624
relation.isAuthorOfPublication887620f2-12aa-49d2-9cad-90c1e4f621d1
relation.isAuthorOfPublication0c2a26b0-8a1e-4c20-8e97-09abcce39e3d
relation.isAuthorOfPublication2f21d3c0-c752-499f-9bcc-d87d9fd31d5c
relation.isAuthorOfPublication.latestForDiscovery887620f2-12aa-49d2-9cad-90c1e4f621d1

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