{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T11:02:54Z","timestamp":1780484574568,"version":"3.54.1"},"reference-count":26,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>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.<\/jats:p><\/jats:sec>Objectives<\/jats:title>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.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>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.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>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.<\/jats:p><\/jats:sec>Results<\/jats:title>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.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.1152","type":"journal-article","created":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T15:24:20Z","timestamp":1742397860000},"page":"e251152","source":"Crossref","is-referenced-by-count":1,"title":["Decisions About Suppressive Antibiotics Among Clinicians at Veterans Affairs Hospitals After Prosthetic Joint Infection"],"prefix":"10.1001","volume":"8","author":[{"given":"Kimberly C.","family":"Dukes","sequence":"first","affiliation":[{"name":"Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City"},{"name":"College of Public Health, University of Iowa, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia Friberg","family":"Walhof","sequence":"additional","affiliation":[{"name":"Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"Hockett Sherlock","sequence":"additional","affiliation":[{"name":"Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Suh","sequence":"additional","affiliation":[{"name":"Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poorani","family":"Sekar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather Schacht","family":"Reisinger","sequence":"additional","affiliation":[{"name":"Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City"},{"name":"Institute for Clinical and Translational Science, University of Iowa, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Alexander","sequence":"additional","affiliation":[{"name":"Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly Richardson","family":"Miell","sequence":"additional","affiliation":[{"name":"Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brice","family":"Beck","sequence":"additional","affiliation":[{"name":"Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Pugely","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Iowa Carver College of Medicine, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marin L.","family":"Schweizer","sequence":"additional","affiliation":[{"name":"William S. Middleton Veterans Affairs Hospital, Madison, Wisconsin"},{"name":"Department of Internal Medicine, School of Medicine and Public Health, University of Wisconsin, Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,3,19]]},"reference":[{"issue":"7","key":"zoi250083r1","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1016\/j.arth.2007.10.017","article-title":"Infection burden for hip and knee arthroplasty in the United States.","volume":"23","author":"Kurtz","year":"2008","journal-title":"J Arthroplasty"},{"issue":"1","key":"zoi250083r2","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1186\/s12891-018-2264-7","article-title":"Infection after knee replacement: a qualitative study of impact of periprosthetic knee infection.","volume":"19","author":"Mallon","year":"2018","journal-title":"BMC Musculoskelet 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