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Early intravenous to oral antibiotic switch therapy is effective in the treatment of infected total hip replacement

Abstract number: P615

Darley E., Bannister G., Blom A., MacGowan A.P., Jacobson S., Alfouzan W.

Objective: To determine outcomes for an antibiotic regimen using early switch to oral antibiotic (AB) for treatment of infected total hip replacements (THR) treated by either 1-stage or 2-stage procedures.

Methods: Cases of infected THR were identified from the microbiology records held on all orthopaedic infections in a 24 month period in North Bristol NHS Trust. Diagnosis was made by microbiological culture of theatre specimens and findings at operation. The total number of THR operations was also determined. Data on organisms cultured and AB treatment regimens were recorded from orthopaedic cases notes, microbiology patient and pathology computer records. AB treatment regimens were tailored for each patient by a medical microbiologist, according to culture and sensitivity results and history of previous THR infection. A standard approach of 10–14 days intravenous (iv) AB followed by a switch to oral ABs either for 6–8 weeks until 2nd stage re-implantation or for 6–26 weeks following a 1 stage procedure, was used. The exact date of oral switch and ultimate AB duration was determined by clinical resolution and the CRP. Outcome was recorded as no microbiological or clinical evidence of relapse of infection, relapse after completing AB course, or unknown.

Results: In 24 months 1854 THR elective operations were performed, 1% for infected THR. 19 patients underwent 2-stage THR, 17/19 were treated with 14 days iv ABs followed by oral ABs for 4–8 weeks. 2/19 patients were treated with iv ABs for the whole duration, 1 for a resistant pseudomonas and 1 patient with co-morbidities who remained in hospital. None of the 19 patients have relapsed. 6 patients underwent 1-stage THR, 4 had 2 weeks iv then 6–26 weeks oral ABs, with no relapse. Case notes are unavailable for the other 2 patients, neither has represented to this hospital Trust for further treatment. Follow up duration for all cases, to date, is 12–24 months.

Conclusions: 17/17 patients treated for infected THR with 2-stage replacement and an AB regimen incorporating early switch from iv to oral ABs have had to date a successful outcome. Early oral AB switch therapy is effective and has an important role enabling patients to return to independence after revision surgery and avoid complications of prolonged iv access.

Session Details

Date: 16/05/2009
Time: 00:00-00:00
Session name: 19th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Helsinki, Finland, 16 - 19 May 2009
Presentation type:
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