Journal article
Associations between suppressive antibiotic therapy, treatment failure, and side effects among young, immunocompetent veterans with prosthetic joint infection who undergo debridement, antibiotics, and implant retention
Antimicrobial stewardship & healthcare epidemiology : ASHE, Vol.6(1), e52
02/23/2026
DOI: 10.1017/ash.2025.10273
PMCID: PMC12936805
PMID: 41767648
Abstract
Objective:
Suppressive antibiotic therapy (SAT) is used to prevent recurrent prosthetic joint infections (PJI) among patients who undergo debridement, antibiotics, and implant retention (DAIR). We aimed to assess SAT outcomes among younger, immunocompetent patients.
Design:
Retrospective cohort study.
Patients:
Immunocompetent patients <65 years of age who received DAIR for PJI of the hip, knee, or shoulder.
Setting:
Veterans Affairs hospitals.
Methods:
SAT was divided into short-term (oral antibiotics given for <3 months after guideline concordant therapy) and long-term SAT (>3 months to 5 years of oral antibiotics). The primary outcome was treatment failure (TF) and mortality combined. SAT was a time-dependent covariate in Cox proportional hazards models.
Results:
Of the 938 patients, 15% received short-term SAT, 20% received long-term SAT, and 65% did not receive SAT. Short- and long-term SAT were significantly associated with decreased hazards of TF or mortality (short-term SAT adjusted hazard ratio (aHR) = 0.27; 95% confidence interval (CI): 0.11, 0.67; Long-term SAT aHR = 0.52; 95% CI: 0.30, 0.89). Short-term SAT was significantly associated with C. difficile infection (aHR: 3.47; 95% CI: 1.38, 8.74). Short-term SAT (aHR: 7.83; 95% CI: 4.80, 12.77) and long-term SAT (aHR: 1.68; 95% CI: 1.19, 2.38) were significantly associated with antibiotic-associated diarrhea. Long-term SAT was not significantly associated with TF alone (aHR = 0.61; 95% CI: 0.32, 1.16).
Conclusions:
SAT was significantly associated with decreased death or TF and increased side effects. Benefits and risks must be weighed before prescribing SAT to younger, immunocompetent patients.
Details
- Title: Subtitle
- Associations between suppressive antibiotic therapy, treatment failure, and side effects among young, immunocompetent veterans with prosthetic joint infection who undergo debridement, antibiotics, and implant retention
- Creators
- Marin Leigh Schweizer - University of Wisconsin–MadisonRajeshwari Nair - University of IowaKelly Richardson Miell - Iowa City VA Health Care SystemJames Merchant - University of IowaBrice Beck - Iowa City VA Health Care SystemBruce Alexander - Iowa City VA Health Care SystemDaniel Suh - University of Iowa, Internal MedicineHiroyuki Suzuki - University of IowaAaron J. Tande - WinnMedMireia Puig-AsensioKimberly C. Dukes - University of IowaJulia Walhof - University of Iowa, Internal MedicineAndrew PugelyAmbar Haleem - University of Wisconsin–MadisonMichael Scolarici - University of Wisconsin–MadisonPoorani Sekar - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Antimicrobial stewardship & healthcare epidemiology : ASHE, Vol.6(1), e52
- DOI
- 10.1017/ash.2025.10273
- PMID
- 41767648
- PMCID
- PMC12936805
- NLM abbreviation
- Antimicrob Steward Healthc Epidemiol
- ISSN
- 2732-494X
- eISSN
- 2732-494X
- Publisher
- Cambridge University Press
- Grant note
- Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development Award: IIR 16-245
This work was funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development Award IIR 16-245 (MS).
- Language
- English
- Date published
- 02/23/2026
- Academic Unit
- Pharmacy; Psychiatry; Infectious Diseases; Epidemiology; General Internal Medicine; Community and Behavioral Health; Internal Medicine
- Record Identifier
- 9985139270602771
Metrics
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