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Abstract
Discussion Forum (0)
Abstract number: 3892

Session Type: ePosters

Session Title: ePosters

Authors(s): B. Young (1, 2), B. Kendrick (1), B. Atkins (1), M. Scarborough (1)

Authors Affiliations(s): (1) Oxford Universtiy Hospitals NHS Foundation Trust, United Kingdom, (2) University of Oxford, United Kingdom

Background:

Prosthetic joint infection (PJI) remains an infrequent but difficult complication of arthroplasty. In 2019, the Oral-versus-Intravenous Antibiotics (OVIVA) trial reported oral antimicrobial therapy was non-inferior to prolonged intravenous antimicrobial treatment for these infections. We investigated how widely early oral switch could be implemented in our setting.

Methods:

We reviewed a cohort of patients undergoing surgical treatment for PJI over 12 months after the reporting of the OVIVA study. The joints involved, surgical treatment, microbiological findings and antimicrobial treatment were recorded.

Results:

135 patients meeting the Musculoskeletal Infection Society criteria for PJI underwent surgical treatment for PJI over 12 months (Table 1). The most common joints involved were total knee arthroplasty (72/135, 53.3%), and total hip arthroplasty (60/136, 44.4%). Surgical treatment of PJI was with Debridement, antibiotics and Implant Retention (DAIR) (n=62, 45.9%), single-stage revision (n=32, 23.7%) and two-stage revision (n=41, 30.4%). 

Staphylococci – including S. aureus and coagulase-negative staphylococci (CoNS) – were the most common infections. Enterococci and Enterobacteriales were the next most frequently cultured, usually in polymicrobial infections (Figure 1). In 11 patients (9%), the isolated organism was resistant to the usual empiric antibiotic regimen of vancomycin and meropenem. Patients with resistant organisms had more previous procedures on the affected joint (median 5, IQR 3.5-6) than those without (median 2, IQR 1-4) (p<0.01, Kruskal-Wallis test).

Intravenous antimicrobials were used for a median of 7 days (range 2-90 days, IQR 5-16). Continuation of intravenous therapy beyond 14 days was most common in polymicrobial infection (12/29, 41.4%) and CoNS infection (8/22, 36.4%). 

122/135 (90.4%) patients were switched to oral antimicrobials, for a median planned duration of 83 days (IQR 37-173). Among these, 25/122 (20.5%) had multiple oral antimicrobial regimens, and 5/122 (4.1%) had 3 or more. 20/122 (16.4%) of patients on oral antimicrobials had treatment changes due to drug intolerance, interactions or adverse effects.

Conclusions:

Early oral antimicrobial therapy was used in the majority of patients with PJI.  Effective oral antimicrobial therapy remains challenging in polymicrobial and CoNS PJI. Multi-drug resistant infection was commonest in patients with multiple previous procedures. Oral antimicrobial therapy for PJI is complex, requiring close supervision and active management. 


 
Abstract number: 3892

Session Type: ePosters

Session Title: ePosters

Authors(s): B. Young (1, 2), B. Kendrick (1), B. Atkins (1), M. Scarborough (1)

Authors Affiliations(s): (1) Oxford Universtiy Hospitals NHS Foundation Trust, United Kingdom, (2) University of Oxford, United Kingdom

Background:

Prosthetic joint infection (PJI) remains an infrequent but difficult complication of arthroplasty. In 2019, the Oral-versus-Intravenous Antibiotics (OVIVA) trial reported oral antimicrobial therapy was non-inferior to prolonged intravenous antimicrobial treatment for these infections. We investigated how widely early oral switch could be implemented in our setting.

Methods:

We reviewed a cohort of patients undergoing surgical treatment for PJI over 12 months after the reporting of the OVIVA study. The joints involved, surgical treatment, microbiological findings and antimicrobial treatment were recorded.

Results:

135 patients meeting the Musculoskeletal Infection Society criteria for PJI underwent surgical treatment for PJI over 12 months (Table 1). The most common joints involved were total knee arthroplasty (72/135, 53.3%), and total hip arthroplasty (60/136, 44.4%). Surgical treatment of PJI was with Debridement, antibiotics and Implant Retention (DAIR) (n=62, 45.9%), single-stage revision (n=32, 23.7%) and two-stage revision (n=41, 30.4%). 

Staphylococci – including S. aureus and coagulase-negative staphylococci (CoNS) – were the most common infections. Enterococci and Enterobacteriales were the next most frequently cultured, usually in polymicrobial infections (Figure 1). In 11 patients (9%), the isolated organism was resistant to the usual empiric antibiotic regimen of vancomycin and meropenem. Patients with resistant organisms had more previous procedures on the affected joint (median 5, IQR 3.5-6) than those without (median 2, IQR 1-4) (p<0.01, Kruskal-Wallis test).

Intravenous antimicrobials were used for a median of 7 days (range 2-90 days, IQR 5-16). Continuation of intravenous therapy beyond 14 days was most common in polymicrobial infection (12/29, 41.4%) and CoNS infection (8/22, 36.4%). 

122/135 (90.4%) patients were switched to oral antimicrobials, for a median planned duration of 83 days (IQR 37-173). Among these, 25/122 (20.5%) had multiple oral antimicrobial regimens, and 5/122 (4.1%) had 3 or more. 20/122 (16.4%) of patients on oral antimicrobials had treatment changes due to drug intolerance, interactions or adverse effects.

Conclusions:

Early oral antimicrobial therapy was used in the majority of patients with PJI.  Effective oral antimicrobial therapy remains challenging in polymicrobial and CoNS PJI. Multi-drug resistant infection was commonest in patients with multiple previous procedures. Oral antimicrobial therapy for PJI is complex, requiring close supervision and active management. 


 
Prosthetic joint infection after the oral versus intravenous antibiotics trial: experience from oral treatment in a referral centre cohort
Dr. Bernadette Young
Dr. Bernadette Young
ESCMID eAcademy. Young B. 07/09/2021; 329605; 3892
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Dr. Bernadette Young
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Abstract
Discussion Forum (0)
Abstract number: 3892

Session Type: ePosters

Session Title: ePosters

Authors(s): B. Young (1, 2), B. Kendrick (1), B. Atkins (1), M. Scarborough (1)

Authors Affiliations(s): (1) Oxford Universtiy Hospitals NHS Foundation Trust, United Kingdom, (2) University of Oxford, United Kingdom

Background:

Prosthetic joint infection (PJI) remains an infrequent but difficult complication of arthroplasty. In 2019, the Oral-versus-Intravenous Antibiotics (OVIVA) trial reported oral antimicrobial therapy was non-inferior to prolonged intravenous antimicrobial treatment for these infections. We investigated how widely early oral switch could be implemented in our setting.

Methods:

We reviewed a cohort of patients undergoing surgical treatment for PJI over 12 months after the reporting of the OVIVA study. The joints involved, surgical treatment, microbiological findings and antimicrobial treatment were recorded.

Results:

135 patients meeting the Musculoskeletal Infection Society criteria for PJI underwent surgical treatment for PJI over 12 months (Table 1). The most common joints involved were total knee arthroplasty (72/135, 53.3%), and total hip arthroplasty (60/136, 44.4%). Surgical treatment of PJI was with Debridement, antibiotics and Implant Retention (DAIR) (n=62, 45.9%), single-stage revision (n=32, 23.7%) and two-stage revision (n=41, 30.4%). 

Staphylococci – including S. aureus and coagulase-negative staphylococci (CoNS) – were the most common infections. Enterococci and Enterobacteriales were the next most frequently cultured, usually in polymicrobial infections (Figure 1). In 11 patients (9%), the isolated organism was resistant to the usual empiric antibiotic regimen of vancomycin and meropenem. Patients with resistant organisms had more previous procedures on the affected joint (median 5, IQR 3.5-6) than those without (median 2, IQR 1-4) (p<0.01, Kruskal-Wallis test).

Intravenous antimicrobials were used for a median of 7 days (range 2-90 days, IQR 5-16). Continuation of intravenous therapy beyond 14 days was most common in polymicrobial infection (12/29, 41.4%) and CoNS infection (8/22, 36.4%). 

122/135 (90.4%) patients were switched to oral antimicrobials, for a median planned duration of 83 days (IQR 37-173). Among these, 25/122 (20.5%) had multiple oral antimicrobial regimens, and 5/122 (4.1%) had 3 or more. 20/122 (16.4%) of patients on oral antimicrobials had treatment changes due to drug intolerance, interactions or adverse effects.

Conclusions:

Early oral antimicrobial therapy was used in the majority of patients with PJI.  Effective oral antimicrobial therapy remains challenging in polymicrobial and CoNS PJI. Multi-drug resistant infection was commonest in patients with multiple previous procedures. Oral antimicrobial therapy for PJI is complex, requiring close supervision and active management. 


 
Abstract number: 3892

Session Type: ePosters

Session Title: ePosters

Authors(s): B. Young (1, 2), B. Kendrick (1), B. Atkins (1), M. Scarborough (1)

Authors Affiliations(s): (1) Oxford Universtiy Hospitals NHS Foundation Trust, United Kingdom, (2) University of Oxford, United Kingdom

Background:

Prosthetic joint infection (PJI) remains an infrequent but difficult complication of arthroplasty. In 2019, the Oral-versus-Intravenous Antibiotics (OVIVA) trial reported oral antimicrobial therapy was non-inferior to prolonged intravenous antimicrobial treatment for these infections. We investigated how widely early oral switch could be implemented in our setting.

Methods:

We reviewed a cohort of patients undergoing surgical treatment for PJI over 12 months after the reporting of the OVIVA study. The joints involved, surgical treatment, microbiological findings and antimicrobial treatment were recorded.

Results:

135 patients meeting the Musculoskeletal Infection Society criteria for PJI underwent surgical treatment for PJI over 12 months (Table 1). The most common joints involved were total knee arthroplasty (72/135, 53.3%), and total hip arthroplasty (60/136, 44.4%). Surgical treatment of PJI was with Debridement, antibiotics and Implant Retention (DAIR) (n=62, 45.9%), single-stage revision (n=32, 23.7%) and two-stage revision (n=41, 30.4%). 

Staphylococci – including S. aureus and coagulase-negative staphylococci (CoNS) – were the most common infections. Enterococci and Enterobacteriales were the next most frequently cultured, usually in polymicrobial infections (Figure 1). In 11 patients (9%), the isolated organism was resistant to the usual empiric antibiotic regimen of vancomycin and meropenem. Patients with resistant organisms had more previous procedures on the affected joint (median 5, IQR 3.5-6) than those without (median 2, IQR 1-4) (p<0.01, Kruskal-Wallis test).

Intravenous antimicrobials were used for a median of 7 days (range 2-90 days, IQR 5-16). Continuation of intravenous therapy beyond 14 days was most common in polymicrobial infection (12/29, 41.4%) and CoNS infection (8/22, 36.4%). 

122/135 (90.4%) patients were switched to oral antimicrobials, for a median planned duration of 83 days (IQR 37-173). Among these, 25/122 (20.5%) had multiple oral antimicrobial regimens, and 5/122 (4.1%) had 3 or more. 20/122 (16.4%) of patients on oral antimicrobials had treatment changes due to drug intolerance, interactions or adverse effects.

Conclusions:

Early oral antimicrobial therapy was used in the majority of patients with PJI.  Effective oral antimicrobial therapy remains challenging in polymicrobial and CoNS PJI. Multi-drug resistant infection was commonest in patients with multiple previous procedures. Oral antimicrobial therapy for PJI is complex, requiring close supervision and active management. 


 

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