While we know that periprosthetic hip and knee infections play by different rules than periprosthetic infections of the shoulder, there is something to learn from this report.
These authors reviewed the records on all irrigation and debridement procedures with polyethylene exchange and two-stage revisions performed from 1996 to 2010 for hip or knee periprosthetic joint infection. They defined 'chronic suppression' as post debridement treatment with oral antibiotics for a minimum of 6 months after an initial course of IV antibiotics. These patients were compared with a matched cohort (ratio of 1:3) who did not receive chronic oral antibiotics.
For the antibiotic-suppression group the five-year infection-free prosthetic survival rate was 68.5% and 41.1% for the non-suppression group. 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 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%).
Comment: The of mix bacteria treated in this study and the types of procedures are different from those we regularly encounter with periprosthetic infections of the shoulder; however, we do subscribe to the use of chronic oral antibiotics after the surgical and IV antibiotic treatment of shoulder infections - most commonly Propionibacterium or coagulase negative Staph. Our approach to shoulders suspected of having a periprosthetic infection is shown in this link.
What is not discussed in this paper and should not be overlooked is the potential risks of long term antibiotics, especially of pseudomembranous enterocolitis from Clostridium Difficile. Patients on a protracted course of antibiotics should be carefully monitored for this and other adverse events.
A final comment is that the delayed, 'stealth' presentation (see this link) of Propionibacterium or coagulase negative Staph infections makes it very difficult to determine an "infection-free prosthetic survival rate" for shoulder infections.
A final comment is that the delayed, 'stealth' presentation (see this link) of Propionibacterium or coagulase negative Staph infections makes it very difficult to determine an "infection-free prosthetic survival rate" for shoulder infections.
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