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P200: No need for initial broad-spectrum empiric antibiotic coverage after surgical drainage of orthopaedic implant infections
© Uckay et al; licensee BioMed Central Ltd. 2013
Published: 20 June 2013
Empiric broad-spectrum antibiotic treatment for orthopaedic implant infections after surgical lavage is common practice while awaiting microbiological results, but lacks evidence.
Our objective was to question the indication of broad-spectrum empiric therapy in this clinical setting.
Single-centre cohort study conducted from 1996 to 2011. Methicillin-resistant Staphylococcus aureus endemicity ranged from 23-32% among clinical S. aureus isolates throughout the study period. Bacteremic cases were excluded.
We retrieved 342 implant infections and followed them for a median of 3.5 years (61 recurred; 18%). Infected implants were arthroplasties (n=186), different plates, nails, or other osteosyntheses. Main pathogens were S. aureu s (163; 49 methicillin-resistant) and coagulase-negative staphylococci (60; 45 methicillin-resistant). Median duration of empiric antibiotic coverage after surgical drainage was 3 days before switching to targeted therapy. Vancomycin was the most frequently used initial empiric agent (147), followed by intravenous co-amoxiclav (44). Most empiric antibiotic regimens (269; 79%) proved sensitive to the causative pathogen, but were too broad in 111 episodes (32%). Although they would have covered 59% of later identified causative pathogens, cephalosporins and penicillins were used only in 44 and 10 cases, respectively. Empiric anaerobic coverage was given in 130 episodes (38%), although only five co-pathogens were anaerobes. Multivariate Cox regression analysis showed that neither susceptible antibiotic coverage (compared to non-susceptible; hazard ratio, 0.7, 95% CI, 0.4-1.2) nor exaggerated broad-spectrum use (hazard ratio, 1.1, 0.8-1.5) changed remission rates.
Provided that surgical drainage is performed, broad-spectrum antibiotic coverage during the first 3 days does not enhance remission of orthopaedic implant infections. If empiric agents are prescribed from the first day of infection, narrow-spectrum penicillins or cephalosporins can be considered to avoid unnecessary broad-spectrum and anti-anaerobic antibiotic use. Randomized controlled trials are needed to confirm our findings.
Disclosure of interest
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.