# Chronic Antibiotic Suppression after Prosthetic Joint Infection: A Target for De-implementation

> **NIH VA I01** · IOWA CITY VA MEDICAL CENTER · 2021 · —

## Abstract

Background: The VA has pledged to reduce overuse of antibiotics, and is a partner in the National Action
Plan to combat antibiotic-resistant bacteria. Overuse of antibiotics can lead to Clostridium difficile infections
among the individuals receiving antibiotics, as well as antibiotic resistance that can complicate treatment of
future infections for all patients. Chronic antibiotic suppression (CAS) is defined as indefinite use of oral
antibiotics following initial guideline recommended intravenous and oral antibiotics. There is evidence that CAS
may be inappropriately used and overused. Thus, there is a critical need to examine how CAS is prescribed,
and who benefits the most, and who is harmed, from CAS therapy. This knowledge can be used to develop an
intervention to de-implement and optimize CAS use. In this study, we will examine CAS treatment for
prosthetic joint infections (PJIs). PJIs occur after hip, knee or shoulder replacement surgery and are associated
with a high clinical and economic impact. In the VHA system, over 10,000 hip, knee or shoulder replacement
surgeries are performed each year and this number, as well as the number of associated PJIs, continues to
increase. Treatment for PJI after hip, knee or shoulder replacement surgery is important to the VA because
osteoarthritis, the most common reason for that surgery, is the fifth most common condition among Veterans.
Our pilot data and other studies have found that many PJI patients are prescribed CAS outside of guideline
recommendations, potentially due to physician fear of a relapse. This inappropriate use can lead to poor
patient outcomes (e.g., C. difficile infection, antibiotic resistance) without any benefit.
Research Plan: The specific aims of this study are: (1) Define patient, infection, and treatment characteristics
that identify patients who would benefit from de-implementation of CAS; (2) Define current provider CAS
prescribing processes and evaluate barriers and facilitators to changing those practices through interviews with
health care providers; and (3) Create a decision model to conduct an economic evaluation of CAS use and
different interventions to de-implement inappropriate CAS use. We expect to document significant variations in
CAS prescribing and identify cost-effective interventions to de-implement CAS or reduce its duration.
 We propose a 3-year mixed methods study to inform efforts for CAS de-implementation. Aim 1 will use a
Corporate Data Warehouse (CDW) database of ~7,500 PJI patients treated at all VA hospitals in a
retrospective cohort comparative effectiveness study to determine specific characteristics that identify those
PJI patients who will benefit from CAS de-implementation. These characteristics may include young age,
infection with a non-virulent pathogen, initial receipt of appropriate antibiotics for PJI caused by
Staphylococcus aureus, or receipt of 2-stage exchange surgery. In Aim 2, we will visit 8 diverse hospitals,
qualitatively explor...

## Key facts

- **NIH application ID:** 10197056
- **Project number:** 5I01HX002370-03
- **Recipient organization:** IOWA CITY VA MEDICAL CENTER
- **Principal Investigator:** Marin Leigh Schweizer
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-09-01 → 2022-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10197056

## Citation

> US National Institutes of Health, RePORTER application 10197056, Chronic Antibiotic Suppression after Prosthetic Joint Infection: A Target for De-implementation (5I01HX002370-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10197056. Licensed CC0.

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