Combined antibiotic therapy spacers either commercial or handmade are superior to monotherapy – a microbiological analysis at the second stage of revision

Category: Scientific Paper

Combined antibiotic therapy spacers either commercial or handmade are superior to monotherapy – a microbiological analysis at the second stage of revision

Publication date: 26/03/24

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Infected arthroplasty: 2-stage revision with mono or multiple AB spacers

Authors

Carvalho AD, Ribau A,
Soares D, Santos AC,
Abreu M, Sousa R

Institute

Department of Orthopaedics
Microbiology, Infectious Disease Porto University Hospital,
Porto (Portugal)

Journal

Journal of Bone and Joint Infection

Take Home message

Multiple-AB spacer is better than single AB spacer;
GV preformed spacers performs better than multiple AB hand-made spacer.

Study details		Score	Range
Subject	Clinical	-	-
Type	Retrospective study	1	1 - 5
Journal	J Bone Joint Inf	2	1 - 3

Summary

58 patients with a hip or knee arthroplasty received a Tecres preformed spacer (G or GV) or a hand-made spacer with G, V and Meropenem (M). Multiple AB spacers are more effective than single AB spacer: fewer positive cultures (failure indication) at 2nd stage

Sample characteristics

58 patients (26M, 32F) with a mean age of 67 Y (39 - 85)
Joint: 22 hips + 36 knees
Spacer type: 14 single AB + 44 multiple AB (24 GV + 20 GVM)
Pathogens: difficult-to-treat 15/58 (25.9%)
Previous surgical treatment for PJI: 28/58 (48.3%)
ASA classification ≥ 3: 29/58; BMI ≥ 30: 20/58; Diabetes: 26/58

Spacer implantation (range)

4,6 months (2 - 6)

FU (range)

46 months

Results

Infection eradication

No signs of recurrence in 49/58 (84.5%). Failure in 9/58 (15.5%)
G failure: 4/14 (28.6%); GV failure: 2/24 (8.3%); GVM failure 3/20 (15%)

Positive cultures analysis

Positive cultures at 2nd stage: 11/58 (19.0%)
Failure: 7/11 (63.6%) with p.ve cultures; 2/47 (4.3%) with n.ve cultures

Multivariate analysis

Single AB spacer is a significant independent prognostic factor for p.ve cultures at 2nd stage

Complications

3 hip dislocations; 2 fractures

Key points

Multiple AB spacer is more effective in PJI than single AB spacer
Preformed GV spacers produce half the failures of handmade GVM spacers
2-stage revision is a viable treatment option for patients with complicated surgical histories or with difficult to treat infections

Find out more about Joint Infection

Score

Study value	Description
*	Retrospective study
* *	Retrospective comparative Retrospective Register study
* * *	Prospective study Systematic review Meta-analysis
* * * *	Randomized controlled trial (RCT)
* * * * *	Randomized controlled trial (RCT)

Journal value	Description
*	Low impact factor (<1.500)
* *	Medium impact factor (>1.500 – <2.500)
* * *	High impact factor (> 2.500)