Decisions About Suppressive Antibiotics Among Clinicians at Veterans Affairs Hospitals After Prosthetic Joint Infection Article Swipe
Kimberly Dukes
,
Julia Friberg Walhof
,
Stacey Hockett Sherlock
,
Dan Suh
,
Poorani Sekar
,
Hiroyuki Suzuki
,
Heather Schacht Reisinger
,
Bruce Alexander
,
Kelly Miell
,
Brice Beck
,
Andrew J. Pugely
,
Marin L. Schweizer
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1001/jamanetworkopen.2025.1152
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1001/jamanetworkopen.2025.1152
Importance Indefinite suppressive antibiotic therapy (SAT) is sometimes prescribed after initial antibiotic treatment for prosthetic joint infection (PJI). Limited evidence on outcomes after SAT exists, and using SAT for patients at low risk who may not need it could be associated with antibiotic resistance and adverse events. Objectives To characterize clinical decision-making about SAT after PJI and identify stewardship intervention opportunities to stop or reduce SAT for patients who may not benefit. Design, Setting, and Participants In this qualitative study, interviews were conducted with 41 clinicians involved in decision-making about SAT after PJI at 8 US Veterans Affairs hospitals between November 1, 2019, and July 31, 2021. Analysis was conducted from June 9, 2020, to August 31, 2022. Main Outcomes and Measures Systematic thematic analysis of transcripts of semistructured interviews was conducted to assess the decision-making process for SAT after PJI, including identifying decision-makers, risks and benefits of SAT, and significant time points that occur before or after the SAT prescribing decision. Results A total of 41 clinicians were interviewed. Interviewees reported a complex, usually patient-specific, sometimes collaborative decision-making process. Decisions were emotionally charged because of serious possible repercussions for patients and limited evidence about benefits and risks associated with SAT. Surgeons and infectious diseases physicians were the primary SAT prescribers. Their initial risk-benefit calculation for SAT usually included whether revision surgery could be performed and what type, the organism, patient factors, and clinical signs of infection, as well as their perception of the existing evidence base for SAT after PJI. Interviewees identified significant time points that occured before or after the SAT prescribing decision, including PJI treatment decisions and follow-up appointments. Other potential decision-makers over time included patients, primary care physicians, and pharmacists. Interviewees identified opportunities to discuss SAT-associated benefits and risks with patients as well as other clinicians. Interviewees wanted more evidence about patient outcomes to inform prescribing decisions and emphasized the importance of clinician autonomy and buy-in for practice change. Conclusions and Relevance This qualitative study found that surgeons and infectious diseases physicians often made initial decisions about SAT and identified other potential decision-makers (patients, primary care physicians, pharmacists) and significant time points that occur before or after the SAT prescribing decision, including PJI treatment decisions and follow-up appointments. Stewardship interventions should take into account decision points for patients with PJI across time and the range of decision-makers, including patients, across time.
Related Topics
Concepts
Medicine
Veterans Affairs
Thematic analysis
Intervention (counseling)
Antimicrobial stewardship
Antibiotic Stewardship
Intensive care medicine
MEDLINE
Antibiotic prophylaxis
Clinical decision making
Family medicine
Antibiotic resistance
Antibiotics
Qualitative research
Internal medicine
Nursing
Social science
Political science
Microbiology
Sociology
Biology
Law
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1001/jamanetworkopen.2025.1152
- https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2831698/dukes_2025_oi_250083_1741798603.04488.pdf
- OA Status
- gold
- References
- 22
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4408613953
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4408613953Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1001/jamanetworkopen.2025.1152Digital Object Identifier
- Title
-
Decisions About Suppressive Antibiotics Among Clinicians at Veterans Affairs Hospitals After Prosthetic Joint InfectionWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2025Year of publication
- Publication date
-
2025-03-19Full publication date if available
- Authors
-
Kimberly Dukes, Julia Friberg Walhof, Stacey Hockett Sherlock, Dan Suh, Poorani Sekar, Hiroyuki Suzuki, Heather Schacht Reisinger, Bruce Alexander, Kelly Miell, Brice Beck, Andrew J. Pugely, Marin L. SchweizerList of authors in order
- Landing page
-
https://doi.org/10.1001/jamanetworkopen.2025.1152Publisher landing page
- PDF URL
-
https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2831698/dukes_2025_oi_250083_1741798603.04488.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
-
https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2831698/dukes_2025_oi_250083_1741798603.04488.pdfDirect OA link when available
- Concepts
-
Medicine, Veterans Affairs, Thematic analysis, Intervention (counseling), Antimicrobial stewardship, Antibiotic Stewardship, Intensive care medicine, MEDLINE, Antibiotic prophylaxis, Clinical decision making, Family medicine, Antibiotic resistance, Antibiotics, Qualitative research, Internal medicine, Nursing, Social science, Political science, Microbiology, Sociology, Biology, LawTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
0Total citation count in OpenAlex
- References (count)
-
22Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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