Impact of antibiotic prophylaxis in second-stage surgery in joint prosthesis infection treated with two-stage exchange. A multicenter case–control study

• Published in: European journal of clinical microbiology & infectious diseases Vol. 43; no. 7; pp. 1319 - 1328
• Main Authors: Barbero Allende, Jose M., Fernández Antón, Encarnación, Gómez-Junyent, Joan, Sorlí Redó, Lluisa, Rodríguez-Pardo, Dolors, Murillo Rubio, Óscar, Fernández Sampedro, Marta, Escudero-Sánchez, Rosa, García Gutiérrez, Manuel, Portillo, Ma Eugenia, Sancho, Ignacio, Rico Nieto, Alicia, Guio Carrión, Laura, Soriano Viladomiu, Alex, Morata Ruiz, Laura, de Abajo Iglesias, Francisco José
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2024; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Amides; Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis - methods; Antibiotics; Biomedical and Life Sciences; Biomedicine; Case studies; Case-Control Studies; Cefazolin; Disease prevention; Drug resistance; Exchanging; Female; Glycopeptides; Gram-negative bacilli; Humans; Infections; Internal Medicine; Joint diseases; Joint Prosthesis - adverse effects; Joint Prosthesis - microbiology; Male; Medical Microbiology; Methicillin; Middle Aged; Original Article; Prophylaxis; Prostheses; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - prevention & control; Pseudomonas; Retrospective Studies; Risk analysis; Risk management; Spain; Surgery; β-Lactam antibiotics; Spain; Antibiotic prophylaxis; Two-stage exchange; Prosthesis-related infections
• ISSN: 0934-9723; 1435-4373; 1435-4373
• DOI: 10.1007/s10096-024-04838-3

Introduction
After two-stage exchange due to prosthetic joint infection (PJI), the new prosthesis carries a high risk of reinfection (RePJI). There isn`t solid evidence regarding the antibiotic prophylaxis in 2nd-stage surgery. The objective of this study is to describe what antibiotic prophylaxis is used in this surgery and evaluate its impact on the risk of developing RePJI.
Methods
Retrospective multicenter case–control study in Spanish hospitals. The study included cases of PJI treated with two-stage exchange and subsequently developed a new infection. For each case, two controls were included, matched by prosthesis location, center, and year of surgery. The prophylaxis regimens were grouped based on their antibacterial spectrum, and we calculated the association between the type of regimen and the development of RePJI using conditional logistic regression, adjusted for possible confounding factors.
Results
We included 90 cases from 12 centers, which were compared with 172 controls. The most frequent causative microorganism was Staphylococcus epidermidis with 34 cases (37.8%). Staphylococci were responsible for 50 cases (55.6%), 32 of them (64%) methicillin-resistant. Gram-negative bacilli were involved in 30 cases (33.3%), the most common Pseudomonas aeruginosa. In total, 83 different antibiotic prophylaxis regimens were used in 2nd-stage surgery, the most frequent a single preoperative dose of cefazolin (48 occasions; 18.3%); however, it was most common a combination of a glycopeptide and a beta-lactam with activity against
Pseudomonas spp
(99 cases, 25.2%). In the adjusted analysis, regimens that included antibiotics with activity against methicillin-resistant staphylococci AND
Pseudomonas spp
were associated with a significantly lower risk of RePJI (adjusted OR = 0.24; 95% IC: 0.09–0.65).
Conclusions
The lack of standardization in 2nd-satge surgery prophylaxis explains the wide diversity of regimens used in this procedure. The results suggest that antibiotic prophylaxis in this surgery should include an antibiotic with activity against methicillin-resistant staphylococci and
Pseudomonas
.