Subcutaneous suppressive antibiotic therapy for bone and joint infections: safety and outcome in a cohort of 10 patients
Optimal treatment of prosthetic joint infection and chronic osteomyelitis consists of surgical removal
of biofilm-embedded bacteria, followed by a 6–12 week course of antimicrobial therapy. However, when
optimal surgery is not feasible, oral prolonged suppressive antibiotic therapy (PSAT) is recommended to prevent
prosthesis loosening and/or relapse of infection. Since 2010, we have used infection salvage therapy using offlabel
subcutaneous (sc) injection of a b-lactamas PSAT for patients in whom oral PSAT is not possible.
A single-centre prospective cohort study (2010–18) reporting treatment modalities, efficacy and
safety in all patients receiving sc PSAT. NCT03403608
The 10 included patients (median age 79 years) had polymicrobial (n"5) or MDR bacterial (n"4) prosthetic
joint infection (knee, n"4; hip, n"3) or chronic osteomyelitis (n"3). After initial intensive therapy, seven
patients received ertapenem, three patients received ceftriaxone and one patient received ceftazidime by sc injection
(one patient received 8 days of ceftriaxone before receiving ertapenem). In one patient, sc PSAT failed
with recurrent signs of infection under treatment. In three patients, sc PSAT had to be discontinued due to side
effects; in only one of these was the sc route implicated (skin necrosis following direct sc injection and not gravity
infusion). Median treatment duration was 433 days. In six patients, sc PSAT was successful with favourable outcome
at the time of writing. Interestingly, three patients with MDR bacterial carriage at baseline lost this under
PSAT during follow-up.
As salvage therapy, sc PSAT delivered by gravity infusion is a safe and interesting alternative when
an optimal surgical strategy is not feasible and no oral treatment is available.