Poor Implant Retention Rate in Patients Treated with Beta-Lactam Antibiotics for Initial Intravenous Empirical Therapy in Acute Periprosthetic Knee Joint Infection

Abstract Background: Beta-lactam antibiotics are frequently selected as initial intravenous empirical therapy in acute periprosthetic joint infection (PJI), but show poor drug migration to the knee joint.Methods: We retrospectively assessed 23 patients undergoing irrigation and debridement surgery for acute PJI after primary TKA. First, we compared the success rate of implant retention between patients receiving beta-lactam antibiotics as initial intravenous empirical therapy and those receiving antibiotics other than beta-lactams. Second, multivariate logistic regression analysis was used to control for confounding factors and to distinguish independent risk factors for the failure of implant retention.Results: Twelve patients received beta-lactam antibiotics as initial intravenous therapy (67% received cefazolin) and 11 patients received antibiotics other than beta-lactams (82% received linezolid). Patients receiving beta-lactam antibiotics had significantly lower implant retention rate than those receiving other antibiotics (5 of 12 patients [42%] versus 10 of 11 patients [91%], respectively, p = 0.027). Logistic regression analysis showed that use of beta-lactam antibiotics as initial intravenous empirical therapy was a significant independent risk factor predicting implant failure.Conclusion: The rate of implant retention was lower in patients administered beta-lactam antibiotics as initial intravenous empirical treatment.