Z Orthop Unfall 2019; 157(05): 510-514
DOI: 10.1055/a-0830-4776
Original Article/Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Outpatient Parenteral Antibiotic Therapy (OPAT) with Peripherally Inserted Central Catheter in Patients with Periprosthetic Joint Infection

Article in several languages: English | deutsch
Hinnerk Baecker
1   Department of Surgery, BG University Hospital Bergmannsheil, Bochum
,
Jan Gessmann
1   Department of Surgery, BG University Hospital Bergmannsheil, Bochum
,
Yannik Hanusrichter
1   Department of Surgery, BG University Hospital Bergmannsheil, Bochum
,
Peter Konrad Zahn
2   Clinic of Anesthesiology, Intensive Care, Palliative and Pain Medicine, BG University Hospital Bergmannsheil, Bochum
,
Thomas A. Schildhauer
1   Department of Surgery, BG University Hospital Bergmannsheil, Bochum
,
Sven Frieler
1   Department of Surgery, BG University Hospital Bergmannsheil, Bochum
› Author Affiliations
Further Information

Publication History

Publication Date:
06 August 2019 (online)

Abstract

Background A key factor in the successful treatment of periprosthetic joint infection is the consistent antimicrobial therapy. Depending on the pathogen antimicrobial susceptibility, intravenous (i. v.) antibiotics may not be switched to oral medication at patient discharge, without risking a treatment failure. The implementation of an outpatient i. v. therapy using peripherally inserted central catheters (PICCs) allows for early discharge with continuation of adequate antimicrobial therapy.

Methods We prospectively evaluated the systematic use of PICC in 11 patients with periprosthetic joint infection. Inclusion criterion was the detection of a pathogen that cannot be optimally treated with oral antibiotics according to the current treatment concept (Trampuz et al.).

Results A total of 12 PICCs in 11 patients were analysed. An error or mechanical nerve irritation was not observed. The occurrence of a catheter-related bloodstream infection (CRBSI) was not recorded. None of our patients had PICC-associated infections, thrombophlebitis or thrombosis. One patient stopped therapy due to a lack of compliance. Ten patients successfully completed their treatment. At a mean follow-up of 29 months, successful infection eradication as measured by the Delphi criteria was achieved in 100%.

Conclusion Although the number of patients included in the study was small, our short-term results suggest a good applicability of PICCs in the outpatient i. v. antimicrobial therapy for treatment of periprosthetic joint infection. Catheter-associated complications could not be observed in our collective. The successful infection control in all cases despite proven difficult-to-treat infection is promising.

 
  • References/Literatur

  • 1 Darouiche RO. Device-associated infections: a macroproblem that starts with microadherence. Clin Infect Dis 2001; 33: 1567-1572
  • 2 Kurtz S, Ong K, Lau E. et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89: 780-785
  • 3 Kurtz SM, Ong KL, Schmier J. et al. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am 2007; 89 (Suppl. 03) S144-S151
  • 4 Winkler T, Tramputz A, Hardt S. et al. [Periprosthetic infection after hip arthroplasty]. Orthopade 2014; 43: 70-78
  • 5 Perka C, Haas N. [Periprosthetic infection]. Chirurg 2011; 82: 218-226
  • 6 Parvizi J, Tan TL, Goswami K. et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty 2018; 33: 1309-1314.e2
  • 7 Parvizi J, Zmistowski B, Berbari EF. et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 2011; 469: 2992-2994
  • 8 Trampuz A, Perka C, Borens O. [Prosthetic joint infection: new developments in diagnosis and treatment]. Dtsch Med Wochenschr 2013; 138: 1571-1573
  • 9 Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med 2004; 351: 1645-1654
  • 10 Trampuz A, Zimmerli W. Diagnosis and treatment of implant-associated septic arthritis and osteomyelitis. Curr Infect Dis Rep 2008; 10: 394-403
  • 11 Renz N, Perka C, Trampuz A. [Management of periprosthetic infections of the knee]. Orthopade 2016; 45: 65-71
  • 12 [Anonym] Prävention von Infektionen, die von Gefäßkathetern ausgehen: Teil 1 – Nichtgetunnelte zentralvenöse Katheter. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60: 171-206
  • 13 [Anonym] Prävention von Infektionen, die von Gefäßkathetern ausgehen: Teil 2 – Periphervenöse Verweilkanülen und arterielle Katheter. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60: 207-215
  • 14 Chopra V, Anand S, Hickner A. et al. Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet 2013; 382: 311-325
  • 15 Chopra V, OʼHoro JC, Rogers MA. et al. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2013; 34: 908-918
  • 16 Yamaguchi RS, Noritomi DT, Degaspare NV. et al. Peripherally inserted central catheters are associated with lower risk of bloodstream infection compared with central venous catheters in paediatric intensive care patients: a propensity-adjusted analysis. Intensive Care Med 2017; 43: 1097-1104
  • 17 Grau D, Clarivet B, Lotthé A. et al. Complications with peripherally inserted central catheters (PICCs) used in hospitalized patients and outpatients: a prospective cohort study. Antimicrob Resist Infect Control 2017; 6: 18
  • 18 Cornillon J, Martignoles JA, Tavernier-Tardy E. et al. Prospective evaluation of systematic use of peripherally inserted central catheters (PICC lines) for the home care after allogeneic hematopoietic stem cells transplantation. Support Care Cancer 2017; 25: 2843-2847
  • 19 Parás-Bravo P, Paz-Zulueta M, Santibañez M. et al. Living with a peripherally inserted central catheter: the perspective of cancer outpatients-a qualitative study. Support Care Cancer 2018; 26: 441-449
  • 20 Mermel LA, Allon M, Bouza E. et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49: 1-45
  • 21 Centers for Disease Control and Prevention (CDC). Vital signs: central line-associated blood stream infections–United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011; 60: 243-248
  • 22 Watson CM, Al-Hasan MN. Bloodstream infections and central line-associated bloodstream infections. Surg Clin North Am 2014; 94: 1233-1244
  • 23 Curto-García N, García-Suárez J, Callejas Chavarria M. et al. A team-based multidisciplinary approach to managing peripherally inserted central catheter complications in high-risk haematological patients: a prospective study. Support Care Cancer 2016; 24: 93-101
  • 24 Kabsy Y, Baudin G, Vinti H. et al. [Peripherally inserted central catheters (PICC) in onco-hematology. PICC line in onco-hematology]. Bull Cancer 2010; 97: 1067-1071
  • 25 Szeinbach SL, Pauline J, Villa KF. et al. Evaluating catheter complications and outcomes in patients receiving home parenteral nutrition. J Eval Clin Pract 2015; 21: 153-159
  • 26 Leroyer C, Lashéras A, Marie V. et al. Prospective follow-up of complications related to peripherally inserted central catheters. Med Mal Infect 2013; 43: 350-355
  • 27 Pedersen MG, Jensen-Fangel S, Olesen HV. et al. Outpatient parenteral antimicrobial therapy (OPAT) in patients with cystic fibrosis. BMC Infect Dis 2015; 15: 290
  • 28 Akgün D, Perka C, Trampuz A. et al. Outcome of hip and knee periprosthetic joint infections caused by pathogens resistant to biofilm-active antibiotics: results from a prospective cohort study. Arch Orthop Trauma Surg 2018; 138: 635-642