The Joint EBJIS-MSIS 2026 Conference

Early switch to oral antibiotics (ABX) for treatment of high-risk periprosthetic joint infection (PJI)

Nicolás Cortés-Penfield MD1, Bryan Alexander PharmD1,2, Molly Miller PharmD1,2, Sara Azimi PharmD1,2, and Mark E. Rupp MD1

1: Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA; 2: Department of Pharmacy, Nebraska Medicine, Omaha, NE, USA

Introduction: Despite increasing evidence supporting oral ABX for PJI (1-3), many clinicians insist on prolonged intravenous (IV) therapy for patients at increased risk of failure. We assessed outcomes associated with early oral ABX transition for PJI patients with a high burden of comorbidities predisposing to treatment failure.

Methods: Retrospective review of outpatient parenteral antibiotic therapy (OPAT) program records of patients treated at our institution from 2019-2025 meeting 2018 MSIS/ICM criteria for infected or possibly infected arthroplasty who transitioned to oral ABX within 2 weeks of surgery. Need for further same site surgery due to relapsed (same pathogen) or recurrent (new pathogen or culture-negative) PJI at 1 year was the primary outcome.

Results: Patient Characteristics (n=20)

65% male, 63 y/o (median age), PJI site: 45% Knee, 35% Hip, 20% Shoulder, 70% had one or more of the following risk factors for treatment failure:

Active malignancy (20%), Obesity (BMI > 30) (15%), Prior revision arthroplasty (15%), CKD or ESRD (10%), Age > 80 y/o (10%), Polymicrobial infection (10%), S. aureus infection (10%), Other (PAD, RA, bacteremia) (5% each). Median duration of IV antibiotics was 12 days post-op (range 2-14 days); 25% received <7d IV antibiotics

Outcomes with Early PO Switch: 19/20 (95%) were free of additional surgery at one year. One pt had recurrent PJI due to E. faecalis and C. striatum at 5 mo. 18/20 (90%) were free of additional surgery at last follow-up. One pt developed acute PJI due to Pasteurella sp at 2 yrs after a cat bite.

Conclusion: This small, retrospective, single center study of early oral antibiotic treatment in a predominantly high-risk cohort is consistent with existing data in complicated orthopaedic infections and justifies a larger prospective trial

The Joint EBJIS-MSIS 2026 Conference

Early switch to oral antibiotics (ABX) for treatment of high-risk periprosthetic joint infection (PJI)

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