• Marcelo B P Siqueira, Anas Saleh, Alison K Klika, Colin O'Rourke, Steven Schmitt, Carlos A Higuera, and Wael K Barsoum.
• Departments of Orthopaedic Surgery (M.B.P.S., A.S., A.K.K., C.A.H., and W.K.B.), Quantitative Health Sciences (C.O'R.), and Infectious Diseases (S.S.), Cleveland Clinic Foundation, Cleveland, OH 44195. E-mail address for M.B.P. Siqueira: bogliom@ccf.org. E-mail address for A. Saleh: anas.ar.saleh@gmail.com. E-mail address for A.K. Klika: klikaa@ccf.org. E-mail address for C. O'Rourke: orourkc@ccf.org. E-mail address for S. Schmitt: schmits@ccf.org. E-mail address for C.A. Higuera: higuerc@ccf.org. E-mail address for W.K. Barsoum: barsouw@ccf.org.
• J Bone Joint Surg Am. 2015 Aug 5; 97 (15): 1220-32.

BackgroundThe clinical benefit of chronic suppression with oral antibiotics as a salvage treatment for periprosthetic joint infection is unclear. The purpose of this study was to compare infection-free prosthetic survival rates between patients who received chronic oral antibiotics and those who did not following irrigation and debridement with polyethylene exchange or two-stage revision for periprosthetic joint infection.MethodsWe reviewed the records on all irrigation and debridement procedures with polyethylene exchange and two-stage revisions performed at our institution from 1996 to 2010 for hip or knee periprosthetic joint infection. Of 625 patients treated with a total of 655 eligible revisions, ninety-two received chronic oral antibiotics for a minimum of six months and were eligible for inclusion in our study. These patients were compared with a matched cohort (ratio of 1:3) who did not receive chronic oral antibiotics.ResultsThe five-year infection-free prosthetic survival rate was 68.5% (95% confidence interval [CI] = 59.2% to 79.3%) for the antibiotic-suppression group and 41.1% (95% CI = 34.9% to 48.5%) for the non-suppression group (hazard ratio [HR] = 0.63, p = 0.008). Stratification by the type of surgery and the infecting organism showed a higher five-year survival rate for the patients in the suppression group who underwent irrigation and debridement with polyethylene exchange (64.7%) compared with those in the non-suppression group who underwent irrigation and debridement with polyethylene exchange (30.4%, p < 0.0001) and a higher five-year survival rate for the patients in the suppression group who had a Staphylococcus aureus infection (57.4%) compared with those in the non-suppression group who had a Staphylococcus aureus infection (40.1%, p = 0.047).ConclusionsChronic suppression with oral antibiotics increased the infection-free prosthetic survival rate following surgical treatment for periprosthetic joint infection. Patients who underwent irrigation and debridement with polyethylene exchange and those who had a Staphylococcus aureus infection had the greatest benefit.Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

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