Local Gentamicin Application Ineffective in Treatment of Periprosthetic Joint Infection

The use of gentamicin-impregnated beads and/or sponges should be discouraged in early acute periprosthetic joint infection, as their use is associated with high failure rates, according to findings published in the Journal of Antimicrobial Chemotherapy.

Gentamicin-impregnated beads and sponges have been used with moderate regularity since their development because of their ability to produce levels of local gentamicin much higher than minimum inhibitory concentration values. However, retrospective analyses have failed to show any benefit in clinical outcome. In this study, researchers sought to determine the efficacy of gentamicin-impregnated beads and/or sponges in a cohort of 386 patients with early acute periprosthetic joint infection using a propensity score analysis to control for confounders. Local gentamicin was applied in 293 patients (75.9%) and not used in the remaining 93 patients (24.1%). Early failure was defined as acute periprosthetic joint infection-related death; need to remove the implant/additional debridement, antibiotics, and implant retention; or persistent infection requiring antibiotic suppressive therapy. Overall failure was defined as implant removal at any time point.

Multivariate analysis showed that the use of local gentamicin was independently associated with early failure (odds ratio 1.97; 95% CI, 1.12-3.48). Propensity matching showed that the early failure rate was 40.3% among patients receiving gentamicin vs 26.0% for those who did not (P =.06). Likewise, the overall failure rate was 5.2% in the gentamicin group vs 2.6% among the nontreated group (P =.40). This 2-fold increase in failure rate associated with the use of gentamicin-treated beads/sponges resulted in the need for a second surgical debridement or implantation removal in many patients.

“Future studies should address whether other types of local antibiotic application may be useful in the treatment of acute periprosthetic joint infections in patients with a high risk of failure,” wrote the study authors.

Reference

Wouthuyzen-Bakker M, Löwik CAM, Knobben BAS, et al. Use of gentamicin-impregnated beads or sponges in the treatment of early acute periprosthetic joint infection: a propensity score analysis [published online Sept 5, 2018]. J Antimicrob Chemother. doi: 10.1093/jac/dky354