Abstract
Purpose
Empirical broad-spectrum antibiotic treatment for orthopaedic implant infections after surgical lavage is common practice while awaiting microbiological results, but lacks evidence.
Methods
This was a single-centre cohort study from 1996 to 2010 with a follow-up of two years.
Results
We retrieved 342 implant infections and followed them up for a median of 3.5 years (61 recurred, 18 %). Infected implants were arthroplasties (n = 186), different plates, nails or other osteosyntheses. The main pathogens were S. aureus (163, 49 methicillin-resistant) and coagulase-negative staphylococci (60, 45 methicillin-resistant). Median duration of empirical antibiotic coverage after surgical drainage was three days before switching to targeted therapy. Vancomycin was the most frequent initial empirical agent (147), followed by intravenous co-amoxiclav (44). Most empirical antibiotic regimens (269, 79 %) proved sensitive to the causative pathogen, but were too broad in 111 episodes (32 %). Cephalosporins and penicillins were used only in 44 and ten cases, respectively, although they would have covered 59 % of causative pathogens identified later. Multivariate Cox regression analysis showed that neither susceptible antibiotic coverage (compared to non-susceptible; hazard ratio 0.7, 95 % confidence interval 0.4–1.2) nor broad-spectrum use (hazard ratio 1.1, 0.8–1.5) changed remission rates.
Conclusions
Provided that surgical drainage is performed, broad-spectrum antibiotic coverage does not enhance remission of orthopaedic implant infections during the first three days. If empirical agents are prescribed from the first day of infection, narrow-spectrum penicillins or cephalosporins can be considered to avoid unnecessary broad-spectrum antibiotic use.
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Acknowledgments
We thank all colleagues of the Orthopedic Service of Geneva University Hospitals. Ilker Uçkay had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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The authors declare that they have no conflict of interest.
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Schindler, M., Gamulin, A., Belaieff, W. et al. No need for broad-spectrum empirical antibiotic coverage after surgical drainage of orthopaedic implant infections. International Orthopaedics (SICOT) 37, 2025–2030 (2013). https://doi.org/10.1007/s00264-013-1924-3
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DOI: https://doi.org/10.1007/s00264-013-1924-3