2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T6b9,Literature on periprosthetic joint infection (PJI) contains varying strategies and definitions of suppressive antimicrobial therapy (SAT). This study aimed to describe current SAT strategies, evaluate their clinical outcomes, and establish a consensus definition of SAT for research and clinical purposes. Following PRISMA guidelines, a systematic review was performed by searching PubMed and EMBASE from their inception to March 10, 2025. All trials and observational studies including ≥10 patients with PJI treated with SAT were eligible. Data on study, patient, and treatment characteristics, definitions and outcomes were extracted. Study quality was appraised using the Methodological Index for Non-randomized Studies tool. A random effects model was used to pool success rates. Definitions were developed through a modified Delphi process. Forty-two studies (n = 2524 patients) were included: 25 from the United States (U.S.) and 17 from Europe. In U.S. literature, SAT was predominantly prescribed for acute PJI managed with debridement, antibiotics, and implant retention (DAIR), whereas European studies primarily involved PJI managed without curative intent. The pooled reported success rate of SAT was 74% (95% CI: 63-85%) for acute PJI treated with DAIR and 70% (95% CI: 63-78%) for chronic PJI treated with DAIR or without surgery. Definitions of SAT were inconsistently reported. Consensus was achieved, resulting in definitions distinguishing SAT from extended antimicrobial therapy (EAT). SAT is inconsistently defined in PJI literature with variation of practice between the U.S. and Europe. To harmonize research and clinical communication, we advocate the use of consensus definitions of SAT and EAT.31:T9ac,Abstract Background Literature on periprosthetic joint infection (PJI) contains varying strategies and definitions of suppressive antimicrobial therapy (SAT). This study aimed to describe current SAT strategies, evaluate their clinical outcomes, and establish a consensus definition of SAT for research and clinical purposes. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was performed by searching PubMed and EMBASE from their inception to 10 March 2025. All trials and observational studies including ≥10 patients with PJI treated with SAT were eligible. Data on study, patient, and treatment characteristics, definitions, and outcomes were extracted. Study quality was appraised using the Methodological Index for Non-Randomized Studies tool. A random effects model was used to pool success rates. Definitions were developed through a modified Delphi process. Results Forty-two studies (N = 2524 patients) were included: 25 from the United States and 17 from Europe. In US literature, SAT was predominantly prescribed for acute PJI managed with debridement, antibiotics, and implant retention (DAIR), whereas European studies primarily involved PJI managed without curative intent. The pooled reported success rate of SAT was 74% (95% confidence interval [CI], 63%–85%) for acute PJI treated with DAIR and 70% (95% CI, 63%–78%) for chronic PJI treated with DAIR or without surgery. Definitions of SAT were inconsistently reported. Consensus was achieved, resulting in definitions distinguishing SAT from extended antimicrobial therapy (EAT). Conclusions Suppressive antimicrobial therapy is inconsistently defined in PJI literature with variation of practice between the United States and Europe. To harmonize research and clinical communication, we advocate the use of consensus definitions of SAT and EAT. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Systematic Review with Expert Consensus: study design Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Systematic Review with Expert Consensus (study design). Clinician-written summaries and actionable practice insights. 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In U.S. literature, SAT was predominantly prescribed for acute PJI managed with debridement, antibiotics, and implant retention (DAIR), whereas European studies primarily involved PJI managed without curative intent. The pooled reported success rate of SAT was 74% (95% CI: 63-85%) for acute PJI treated with DAIR and 70% (95% CI: 63-78%) for chronic PJI treated with DAIR or without surgery. Definitions of SAT were inconsistently reported. Consensus was achieved, resulting in definitions distinguishing SAT from extended antimicrobial therapy (EAT).","abstract":"$30","keywords":["antimicrobial therapy","prosthetic joint infection","systematic review"],"pubmed_id":"41973995","conclusions":"SAT is inconsistently defined in PJI literature with variation of practice between the U.S. and Europe. 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populations.","value_numeric":null},{"paper_doi":"10.1093/cid/ciag251","tag_type":"warning","value":"Level of evidence assigned as 3 (systematic review of observational studies) rather than 1, given the absence of randomized trials in the included literature.","value_numeric":null},{"paper_doi":"10.1093/cid/ciag251","tag_type":"warning","value":"No RCTs were included; all evidence is from observational studies, so the pooled success rates should be interpreted cautiously.","value_numeric":null},{"paper_doi":"10.1093/cid/ciag251","tag_type":"warning","value":"The consensus definitions (SAT vs. EAT) are newly proposed and not yet validated in prospective studies.","value_numeric":null}],"summaries":{"what_studied":"A systematic review (42 studies, n=2,524 PJI patients) evaluated current suppressive antimicrobial therapy (SAT) strategies, clinical outcomes, and definitional inconsistencies in periprosthetic joint infection (PJI), followed by a modified Delphi consensus process to standardize SAT terminology.","key_result":"Pooled SAT success rate was **74% (95% CI: 63–85%)** for acute PJI managed with DAIR, and **70% (95% CI: 63–78%)** for chronic PJI treated with DAIR or without surgery; U.S. studies focused on DAIR-based SAT while European studies used SAT mainly without curative intent, and a consensus definition distinguishing SAT from extended antimicrobial therapy (EAT) was established.","limitations":"- All included studies were observational (no RCTs), limiting causal inference.\n- Wide confidence intervals and heterogeneity in definitions across 42 studies reduce precision of pooled estimates.\n- Practice and patient selection differences between U.S. and European cohorts may confound comparisons.","practice_takeaway":"When prescribing long-term antibiotics after PJI, use the new consensus definitions to distinguish SAT (indefinite suppression) from EAT (time-limited extended therapy), as this affects how outcomes are reported and compared. Expect roughly 70–74% success with SAT across both acute and chronic PJI scenarios, but recognize this evidence comes entirely from observational data."}}],"initialOffset":1,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"study_design","value":"Systematic Review with Expert Consensus"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Study Designs","href":"/hub/tag/study_design"},{"name":"Systematic Review with Expert Consensus"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"study_design","hub_tag_value":"Systematic Review with Expert Consensus"}}}]]

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