Responders as percent of overall members in each category: Region: New England 50 (58% of 86 members) 19 (51% of 37 members) 3 (33% of 9 members)

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1 Infectious Diseases Society of America Emerging Infections Network Report for Query: Prosthetic Joint Infections (PJI) in Adults Overall response rate: 556/118 (4.2%) physicians responded from 5/16/12 to 6//12. Note: Not all respondents answered all questions, so totals for individual questions vary. This survey was sent only to EIN members with an adult infectious diseases practice. Responders as percent of overall members in each category: Region: New England (58% of 86 members) Mid Atlantic 84 (46% of 184 members) East North Central 81 (4% of 11 members) West North Central 53 (% of 5 members) South Atlantic 93 (43% of 21 members) East South Central (56% of 54 members) West South Central 3 (4% of 9 members) Mountain (4% of 64 members) Pacific 89 (46% of 194 members) Puerto Rico 1 (% of 5 members) Canada 8 (42% of 19 members) Years experience since ID fellowship: <5 years 118 (43% of 25 members) (38% of 346 members) (52% of 284 members) 25 1 (59% of 23 members) Employment: Hospital/clinic 153 (4% of 32 members) Private/group practice 1 (46% of 383 members) University/medical school 188 (49% of 386 members) VA and military 35 (48% of 3 members) State gov t 3 (33% of 9 members) Primary hospital type: Community Non-university teaching University VA hospital or DOD City/county Other 14 (42% of 353 members) 166 (49% of 338 members) 181 (% of 3 members) 34 (45% of 6 members) 19 (51% of 3 members) 9 (64% of 14 members) *Respondents were significantly more likely than non-respondents to have at least 15 years of ID experience (p<.1). 85 members responded by that they do not see prosthetic joint infections; these individuals are not included in further analyses. Page 1

2 Question 2: A 55 year old man without significant comorbidities, normal renal function, and no known allergies is diagnosed with a prosthetic joint infection. The prosthesis is explanted and you are consulted. What are your preferred choices of antibiotics for each of the organisms (any joint) below? Not shown: Other responses; any agent selected by fewer than respondents. All values are percentages based on the overall number of respondents who answered the question MSSA N=41 Oxa Cef CTX Van Dap N=41 N= MRSA Van Dap LZD CTL Oxacillin-susceptible CoNS Oxa Cef Van CTX Dap LZD N= Oxacillin-resistant CoNS Van Dap LZD CTL Propionibacterium spp. Abbreviations used: Oxa = oxacillin/nafcillin Cef = cefazolin CTX = ceftriaxone Van = vancomycin Dap = daptomycin LZD = linezolid CTL = ceftaroline Pen = penicillin Clin = clindamycin N=453 Van Pen CTX Clin Cef Dap LZD CoNS = coagulase-negative staphylococci MSSA = methicillin susceptible S. aureus MRSA = methicillin resistant S. aureus Page 2

3 Question 2 (continued): A 55 year old man without significant comorbidities, normal renal function, and no known allergies is diagnosed with a prosthetic joint infection. The prosthesis is explanted and you are consulted. What are your preferred choices of antibiotics for each of the joints below? Not shown: Other responses; any agent selected by fewer than respondents. % % % % % % % % % % % TREATMENT OF CULTURE-NEGATIVE PJI Knee (N=463) Hip (N=462) Shoulder (N=458) three drugs two drugs one drug Number of respondents for each cell shown (not percentage) One drug: Knee (8) Hip (84) Shoulder (111) Vancomycin Ceftriaxone Cefazolin Two drugs: Knee (313) Hip (31) Shoulder (291) Vancomycin + a fluoroquinolone Vancomycin + ceftriaxone Vancomycin + cefepime Vancomycin + ertapenem Vancomycin + pip/tazobactam Vancomycin + other 9 9 Vancomycin + daptomycin 8 9 Vancomycin + ceftazidime 9 9 Vancomycin + cefazolin Daptomycin + ertapenem Vancomycin + amp/sulbactam 2 2 Vancomycin + clindamycin 1 2 Three drugs: Knee (63) Hip (61) Shoulder (5) Vancomycin + a fluoroquinolone other Vancomycin + daptomycin + linezolid Vancomycin + cefepime + other Page 3

4 Question 1. Percent of all patients with PJI that you treat that are culture-negative: None or <1% 8 (2%) 1-9% 95 (22%) -19% 14 (33%) -29% 3 (23%) -39% 39 (9%) -49% 15 (3%) -59% 24 (5%) % 8 (2%) Question 3. Percentage of patients with staphylococcal prosthetic joint infection managed with implant retention that you treat with adjunctive rifampin: None 1-25% 26-% >% Number of respondents choosing each category is shown Question 4. Rank of the most important considerations when selecting antibiotics for prosthetic joint infections (assuming in vitro susceptibility and equivalent efficacy): Ease of administration Adverse events profile Drug interactions Cost of drug/insurance aspects Monitoring requirements Patient preference Mean Median Least important Most important Page 4

5 Question 5a. Most frequent duration of antibiotic treatment chosen for PJI managed with implant removal: <4 weeks 2 (.4%) 4 to <6 weeks 88 (19%) 6 to <8 weeks 359 (%) 8 weeks 19 (4%) Question 5b. During the planned treatment duration selected above, do you routinely switch from IV to oral antibiotics? No 389 (84%) Yes 3 (16%) Question 6. Ranking of items that influence your decision to stop antibiotic therapy Clinical response Inflammatory markers Completion of pre-determined course Mean Imaging Median Least important Most important Question. When electing to use oral antibiotics for suppression of PJI with retained hardware (after completion of IV treatment course), average duration recommended: Months (23%) Years 166 (35%) Lifelong 1 (41%) Do not use oral suppression 5 (1%) Page 5

6 Question 8. Total inpatient beds in primary hospital: < 49 (%) (29%) (22%) (15%) > 114 (24%) Question 9a. Do you ever oversee patients IV antibiotics after discharge? No involvement in OPAT 23 (5%) Rarely or occasionally oversee OPAT for selected patients 48 (%) Yes (85%) Question 9b. Number of patients you discharge on IV antibiotics in an average month of clinical service: For all indications For bone and joint infections < 24 (53%) 31 (84%) (39%) 63 (14%) > 3 (8%) (2%) Page 6