Implant Removal in the Management of Prosthetic Joint Infection by Staphylococcus aureus: Outcome and Predictors of Failure in a Large Retrospective Multicenter Study

Antibiotics

MªDolores del Toro¹  Julia Praena-Segovia²  Laura Morata³  Luis Falgueras⁴  Oscar Murillo⁵  Joan Gómez-Junyent⁵  Javier Ariza⁵  JoseAntonio Iribarren⁶  Javier Cobo⁷  Josu Baraia-Etxaburu⁸  Luisa Sorlí⁹  Alberto Bahamonde^1,10  Jaime Lora-Tamayo^1,11  Mar Sánchez-Somolinos^1,12  Melchor Riera^1,13  Dolors Rodriguez-Pardo^1,14  Carles Pigrau^1,14  Natividad Benito^1,15  Alfredo Jover-Sáenz^1,16  Alicia Rico^1,17  Elena Muñez^1,18 

[1] Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena, Department of Medicine, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS), 41009 Seville, Spain;Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain;Department of Infectious Diseases, Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, 08036 Barcelona, Spain;Department of Infectious Diseases, Hospital Universitari Parc Taulí, 08208 Sabadell, Spain;Department of Infectious Diseases, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, 08907 L’Hospitalet de Llobregat, Spain;Department of Infectious Diseases, Hospital Universitario Donostia, Universidad del País Vasco (EHU/UPV), 20014 San Sebastián, Spain;Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;Department of Infectious Diseases, Hospital Universitario de Basurto, 48013 Bilbao, Spain;Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;Department of Internal Medicine, Hospital El Bierzo, 24411 Ponferrada, Spain;Department of Internal Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain;Fundació Institut d’Investigació Sanitària Illes Balears, Hospital Universitari Son Espases, 07120 Palma, Spain;Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau- Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain;Territorial Unit of Nosocomial Infections, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain;Unit of Infectious Diseases and Clinical Microbiology, Hospital Universitario La Paz, 28046 Madrid, Spain;Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario Puerta de Hierro, 28220 Madrid, Spain;

关键词: Staphylococcus aureus;    prosthetic joint infection;    implant removal;    outcome;    rifampin;   

DOI  :  10.3390/antibiotics10020118

来源: DOAJ

【 摘 要 】

Objectives: To compare the characteristics and outcomes of cases with acute prosthetic joint infection (PJI; early post-surgical or hematogenous) by Staphylococcus aureus managed with implant removal (IRm) or debridement and retention (DAIR). To analyze the outcomes of all cases managed with IRm (initially or after DAIR failure). Methods: Retrospective, multicenter, cohort study of PJI by S. aureus (2003–2010). Overall failure included mortality within 60 days since surgery and local failure due to staphylococcal persistence/relapse. Results: 499 cases, 338 initially managed with DAIR, 161 with IRm. Mortality was higher in acute PJI managed initially with IRm compared to DAIR, but not associated with the surgical procedure, after propensity score matching. Underlying conditions, hemiarthroplasty, and methicillin-resistant S. aureus were risk factors for mortality. Finally, 249 cases underwent IRm (88 after DAIR failure); overall failure was 15.6%. Local failure (9.3%) was slightly higher in cases with several comorbidities, but independent of previous DAIR, type of IRm, and rifampin treatment. Conclusions: In a large multicenter study of S. aureus PJI managed with IRm, failure was low, but mortality significant, especially in cases with acute PJI and underlying conditions, but not associated with the IRm itself. Rifampin efficacy was limited in this setting.

【 授权许可】

Unknown