Analysis Of The Correlation Between The Duration Of Antibiotic Treatment And The Curative Effect After Two-stage Revision Of Periprosthetic Joint Infection

Purpose: The duration of antibiotic use after operation is an essential factor that affects the two-stage revision of periprosthetic joint infection(PJI).Short-term use of antibiotics cannot effectively control infection,and long-term use of antibiotics will have adverse effects on patients.Therefore,under the premise of ensuring the control of infection,it has significant clinical significance to try to shorten the course of antibiotic treatment and reduce its side effects.The purpose of this study was to investigate the clinical significance of antibiotic application duration in PJI two-stage revision.Methods: Multicenter retrospective analysis was made on the patients who received standard two-stage revision surgery due to chronic PJI in the three different hospitals and used antibiotics after the revision from January 2010 to January 2019.Patients were divided into a short course group(≤1 month)and a long course group(>1month)according to the length of antibiotic treatment.Inclusion criteria: Patients diagnosed with PJI according to Musculoskeletal Infection Society(MSIS)criteria received initial revision of PJI in two stages,>18 years of age.Exclusion criteria:infections such as fungi or mycobacteria,multi-drug resistant bacteria infections,combined with other diseases,such as immunodeficiency,liver and kidney dysfunction,etc.Statistical analysis of patient demographics,laboratory tests,antibiotic regimen,antibiotic course,and antibiotic-related complications.The Kaplan-Meier survival curve was plotted,and the Log Rank method was used to evaluate the effect of antibiotic duration on infection control rate after the two-stage revision,and further analyzed the risk factors related to the failure of the two-stage PJI by the COX regression model.Results: A total of 127 patients treated with antibiotics after the second-stage revision were screened.Twenty cases were excluded,of which 3 died and 17 were lost to follow-up.Finally,107 cases were included with a follow-up rate of 84.3%.There were 65 cases in the short course group and 42 cases in the long course group,and 101 cases were infected.The overall infection control rate was 94.4%.There was no significant difference in infection control rates between the two groups(P = 0.677).Log Rank analysis showed statistically significant differences between the two groups of methicillin-resistant Staphylococcus and body mass index(BMI)(P<0.05).Further COX regression analysis showed BMI≥25kg / m(P = 0.014)and methicillin-resistant grapes Coccus infection(P=0.001)was an independent risk factor for infection recurrence after two-stage revision.Conclusions: after two-stage revision of Periprosthetic Joint Infection,the use of short-term antibiotics did not increase the infection rate.There were fewer side effects than long-term antibiotics.Long-term antibiotics may not be necessary.Obesity and methicillin-resistant Staphylococcus infection are risk factors for infection recurrence after second-stage revision,but the results still need further research to verify.