antibiotics
Review
Suppressive Antibiotic Treatment in Prosthetic Joint Infections:
A Perspective
Javier Cobo and Rosa Escudero-Sanchez *
Citation: Cobo, J.; Escudero-Sanchez,
R. Suppressive Antibiotic Treatment
in Prosthetic Joint Infections: A
Perspective. Antibiotics 2021, 10, 743.
https://doi.org/10.3390/
antibiotics10060743
Academic Editor: Giovanna Batoni
Received: 24 May 2021
Accepted: 15 June 2021
Published: 19 June 2021
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Infectious Disease Department, Hospital Ramón y Cajal, IRYCIS, Ctra. Colmenar Viejo, 28034 Madrid, Spain;
javier.cobo@salud.madrid.org
* Correspondence: rosa.escudero0@gmail.com
Abstract: The treatment of prosthetic joint infections (PJIs) is a complex matter in which surgical,
microbiological and pharmacological aspects must be integrated and, above all, placed in the context
of each patient to make the best decision. Sometimes it is not possible to offer curative treatment
of the infection, and in other cases, the probability that the surgery performed will be successful
is considered very low. Therefore, indefinite administration of antibiotics with the intention of
“suppressing” the course of the infection becomes useful. For decades, we had little information
about suppressive antibiotic treatment (SAT). However, due to the longer life expectancy and increase
in orthopaedic surgeries, an increasing number of patients with infected joint prostheses experience
complex situations in which SAT should be considered as an alternative. In the last 5 years, several
studies attempting to answer the many questions that arise on this issue have been published. The
aim of this publication is to review the latest published evidence on SAT.
Keywords: suppressive antibiotic treatment; prosthetic joint infection; prolonged antibiotic
1. Therapeutic Options for Prosthetic Joint Infections
The goal of treating a prosthetic joint infection (PJI) is to eradicate the infection
and to maintain or regain implant function. This often involves the replacement of the
prostheses, although in some cases (acute infections), the original implant can be salvaged
through extensive debridement and prolonged antibiotic therapy, which is referred to as
DAIR (debridement, antibiotics and implant retention) [1]. In the remaining situations,
the cure can be obtained only by removing the implant, followed by the placement of a
new prosthesis, either during the same surgical procedure (one-stage revision) or after a
period with antibiotics (two-stage revision) [2]. However, reimplantation is sometimes
not possible after removal (resection arthroplasty), and in rare situations, amputation may
be necessary. Eventually, due to the patient’s conditions or the anticipated sequelae of
the intervention, a potentially curative surgical intervention is waived. In this scenario,
orthopaedic surgeons turn their gaze to infectious disease (ID) consultants. Can antibiotic
treatment help the patient?
2. Concept and Definition of Suppressive Antibiotic Treatment (SAT)
The term "suppressive antibiotic treatment" (SAT) refers to the administration of
antibiotics in the long term or indefinitely over time. In the area of PJI, SAT is considered a
“noncurative” strategy, in which antimicrobials are administered with the aim of reducing
symptoms and delaying or preventing the progression of PJI that needs a surgical procedure
to be cured that, for some reason, will not be performed (at least for a prolonged period of
time). SAT can also be used in situations in which adequate surgical treatment is performed
and the probability of cure is considered very low.
Antibiotics 2021, 10, 743. https://doi.org/10.3390/antibiotics10060743 https://www.mdpi.com/journal/antibiotics