The prognosis of streptococcal prosthetic bone and joint infections depends on surgical management-A multicenter retrospective study.
Aged
Aged, 80 and over
Anti-Bacterial Agents
/ therapeutic use
Bone Diseases
/ drug therapy
Combined Modality Therapy
Debridement
Drug Therapy, Combination
Female
Hip Prosthesis
/ adverse effects
Humans
Joint Diseases
/ drug therapy
Knee Prosthesis
/ adverse effects
Levofloxacin
/ therapeutic use
Male
Prognosis
Prosthesis-Related Infections
/ drug therapy
Recurrence
Retrospective Studies
Rifampin
/ therapeutic use
Streptococcal Infections
/ drug therapy
Streptococcus
/ isolation & purification
Streptococcus agalactiae
/ isolation & purification
Treatment Failure
Treatment Outcome
Antibiotic
Debridement
Prosthetic bone and joint infection
Streptococcal
Journal
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
ISSN: 1878-3511
Titre abrégé: Int J Infect Dis
Pays: Canada
ID NLM: 9610933
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
received:
18
05
2019
revised:
11
06
2019
accepted:
12
06
2019
pubmed:
19
6
2019
medline:
28
10
2019
entrez:
19
6
2019
Statut:
ppublish
Résumé
The optimal treatment of streptococcal prosthetic joint infections (PJIs) is unclear. A cohort of streptococcal PJIs was reviewed retrospectively in seven reference centers for the management of complex bone and joint infections, covering the period January 1, 2010 to December 31, 2012. Seventy patients with monomicrobial infections were included: 47 had infections of total hip arthroplasty and 23 had infections of total knee arthroplasty. The median age was 77 years (interquartile range (IQR) 69-83 years), the median Charlson comorbidity score was 4 (IQR 3-6), and 15.6% (n=11) had diabetes. The most commonly identified streptococcal species were Streptococcus agalactiae and Streptococcus dysgalactiae (38.6% (n=27) and 17.1% (n=12), respectively). Debridement, antibiotics and implant retention (DAIR) was performed after a median time of 7 days (IQR 3-8 days), with polyethylene exchange (PE) in 21% of cases. After a minimum follow-up of 2 years, 27% of patients had relapsed, corresponding to 51.4% of DAIR treatment cases and 0% of one-stage (n=15) or two-stage (n=17) exchange strategy cases. Rifampicin or levofloxacin in combination therapy was not associated with a better outcome (adjusted p= 0.99). S. agalactiae species and DAIR treatment were associated with a higher risk of failure. On multivariate analysis, only DAIR treatment and S. agalactiae were independent factors of relapse. Compared to DAIR without PE, DAIR with PE was only associated with a trend towards a benefit (odds ratio 0.33, 95% confidence interval 0.06-1.96; adjusted p= 0.44). Streptococcal PJIs managed with DAIR have a poor prognosis and S. agalactiae seems to be an independent factor of treatment failure.
Sections du résumé
BACKGROUND
BACKGROUND
The optimal treatment of streptococcal prosthetic joint infections (PJIs) is unclear.
METHODS
METHODS
A cohort of streptococcal PJIs was reviewed retrospectively in seven reference centers for the management of complex bone and joint infections, covering the period January 1, 2010 to December 31, 2012.
RESULTS
RESULTS
Seventy patients with monomicrobial infections were included: 47 had infections of total hip arthroplasty and 23 had infections of total knee arthroplasty. The median age was 77 years (interquartile range (IQR) 69-83 years), the median Charlson comorbidity score was 4 (IQR 3-6), and 15.6% (n=11) had diabetes. The most commonly identified streptococcal species were Streptococcus agalactiae and Streptococcus dysgalactiae (38.6% (n=27) and 17.1% (n=12), respectively). Debridement, antibiotics and implant retention (DAIR) was performed after a median time of 7 days (IQR 3-8 days), with polyethylene exchange (PE) in 21% of cases. After a minimum follow-up of 2 years, 27% of patients had relapsed, corresponding to 51.4% of DAIR treatment cases and 0% of one-stage (n=15) or two-stage (n=17) exchange strategy cases. Rifampicin or levofloxacin in combination therapy was not associated with a better outcome (adjusted p= 0.99). S. agalactiae species and DAIR treatment were associated with a higher risk of failure. On multivariate analysis, only DAIR treatment and S. agalactiae were independent factors of relapse. Compared to DAIR without PE, DAIR with PE was only associated with a trend towards a benefit (odds ratio 0.33, 95% confidence interval 0.06-1.96; adjusted p= 0.44).
CONCLUSIONS
CONCLUSIONS
Streptococcal PJIs managed with DAIR have a poor prognosis and S. agalactiae seems to be an independent factor of treatment failure.
Identifiants
pubmed: 31212103
pii: S1201-9712(19)30257-7
doi: 10.1016/j.ijid.2019.06.012
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Levofloxacin
6GNT3Y5LMF
Rifampin
VJT6J7R4TR
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
175-181Informations de copyright
Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.