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Patients with Staphylococcal periprosthetic joint infections: safety and tolerability of fluoroquinolones


Fluoroquinolones are known to be accompanied by significant risks. However, the incidence of adverse events resulting in unplanned drug discontinuation when used for periprosthetic joint infections ( PJI ) is currently unknown.

The study included 156 patients over the age of 18 treated for staphylococcal periprosthetic joint infections with debridement, antibiotics, and implant retention ( DAIR ), between January 1, 2007 and November 21, 2019.
Of the 156 patients, 64 had total hip arthroplasty ( THA ) and 92 had total knee arthroplasty ( TKA ) infections.

The primary outcome was rate of unplanned drug discontinuation. Secondary outcomes included incidence of severe adverse events, unplanned Rifamycin discontinuation, mean time to unplanned regimen discontinuation, and all-cause mortality.

Overall, unplanned drug discontinuation occurred in 35.6% of patients in the fluoroquinolone group and 3% of patients in the non-fluoroquinolone group.
The rate of unplanned discontinuation of fluoroquinolone regimens as compared to non- fluoroquinolone regimens was 27.5% vs 4.2% ( p=0.021 ) in total hip arthroplasty infections and 42% vs 2.4% ( p less than 0.001 ) in total knee arthroplasty infections.

There was no significant difference in severe adverse effects between fluoroquinolone and non- fluoroquinolone regimens in both total hip arthroplasty and total knee arthroplasty infections.

The overall rate of non-severe adverse effects in fluoroquinolone compared to non-fluoroquinolone regimens was 43.3% versus 6.1% ( p less than 0.001 ).

Fluoroquinolones were associated with tendinopathy, myalgia, arthralgia, and nausea.

In conclusion, a significantly higher rate of unplanned drug discontinuation was associated with fluoroquinolone as compared to non-fluoroquinolone regimens.
This provides a real-world view of the implications of fluoroquinolone related adverse events on unplanned discontinuation when used in prolonged durations for the management of staphylococcal periprosthetic joint infections. ( Xagena )

Vollmer NJ et al, Clin Infect Dis 2021; Online ahead of print

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