Prognosis of unexpected positive intraoperative cultures in arthroplasty revision: A large multicenter cohort.
Arthritis
Biofilm
Foreign-boy infection
Infected arthroplasty
Prosthetic joint infection
Journal
The Journal of infection
ISSN: 1532-2742
Titre abrégé: J Infect
Pays: England
ID NLM: 7908424
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
21
05
2021
revised:
14
08
2021
accepted:
03
09
2021
pubmed:
13
9
2021
medline:
15
12
2021
entrez:
12
9
2021
Statut:
ppublish
Résumé
The positive-intraoperative-cultures-type prosthetic joint infection (PIOC-PJI) is considered when surgical cultures yield microorganisms in presumed aseptic arthroplasty revisions. Herein we assess the risk factors for failure in the largest cohort of PIOC-PJI patients reported to date. A retrospective, observational, multicenter study was performed during 2007-2017. Surgeries leading to diagnose PIOC-PJI included only one-stage procedures with either complete or partial prosthesis revision. Failure was defined as recurrence caused by the same microorganism. 203 cases were included (age 72 years, 52% females). Coagulase-negative staphylococci (n = 125, 62%) was the main etiology, but some episodes were caused by virulent bacteria (n = 51, 25%). Prosthesis complete and partial revision was performed in 93 (46%) and 110 (54%) cases, respectively. After a median of 3.4 years, failure occurred in 17 episodes (8.4%, 95%CI 5.3-13.1). Partial revision was an independent predictor of failure (HR 3.63; 95%CI 1.03-12.8), adjusted for gram-negative bacilli (GNB) infection (HR 2.68; 95%CI 0.91-7.89) and chronic renal impairment (HR 2.40; 95%CI 0.90-6.44). Treatment with biofilm-active antibiotics (rifampin/fluoroquinolones) had a favorable impact on infections caused by staphylococci and GNB. Overall prognosis of PIOC-PJI is good, but close follow-up is required in cases of partial revision and in infections caused by GNB.
Sections du résumé
BACKGROUND
The positive-intraoperative-cultures-type prosthetic joint infection (PIOC-PJI) is considered when surgical cultures yield microorganisms in presumed aseptic arthroplasty revisions. Herein we assess the risk factors for failure in the largest cohort of PIOC-PJI patients reported to date.
METHODS
A retrospective, observational, multicenter study was performed during 2007-2017. Surgeries leading to diagnose PIOC-PJI included only one-stage procedures with either complete or partial prosthesis revision. Failure was defined as recurrence caused by the same microorganism.
RESULTS
203 cases were included (age 72 years, 52% females). Coagulase-negative staphylococci (n = 125, 62%) was the main etiology, but some episodes were caused by virulent bacteria (n = 51, 25%). Prosthesis complete and partial revision was performed in 93 (46%) and 110 (54%) cases, respectively. After a median of 3.4 years, failure occurred in 17 episodes (8.4%, 95%CI 5.3-13.1). Partial revision was an independent predictor of failure (HR 3.63; 95%CI 1.03-12.8), adjusted for gram-negative bacilli (GNB) infection (HR 2.68; 95%CI 0.91-7.89) and chronic renal impairment (HR 2.40; 95%CI 0.90-6.44). Treatment with biofilm-active antibiotics (rifampin/fluoroquinolones) had a favorable impact on infections caused by staphylococci and GNB.
CONCLUSION
Overall prognosis of PIOC-PJI is good, but close follow-up is required in cases of partial revision and in infections caused by GNB.
Identifiants
pubmed: 34509512
pii: S0163-4453(21)00452-7
doi: 10.1016/j.jinf.2021.09.001
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
542-549Investigateurs
Javier Cobo Reinoso
(JC)
Ma Ángeles Meléndez-Carmona
(M)
Esther Viedma
(E)
Maria Carmen Fariñas
(MC)
Carlos Salas-Venero
(C)
Pablo S Corona
(PS)
Mayli Lung
(M)
Laura Morata
(L)
Alex Soriano
(A)
Eva Benavent
(E)
Oriol Gasch
(O)
Lluís Falgueras
(L)
Jose Bravo-Ferrer Acosta
(JB)
X Kortajarena
(X)
M A Goenaga
(MA)
Libe Asua Mentxaca
(LA)
Iraia Arteagoitia Colino
(IA)
Eva Cuchí Burgos
(EC)
Lluís Font-Vizcarra
(L)
Patricia Ruiz Garbajosa
(PR)
Eva María Romay Lema
(EMR)
Alejandro López-Pardo Pardo
(AL)
Ferran Pérez-Villar
(F)
Alba Bellés-Bellés
(A)
Jaime Esteban
(J)
Joaquín García-Cañete
(J)
Commentaires et corrections
Type : ErratumIn
Informations de copyright
Copyright © 2021 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing interest All authors certifies no potential conflicts of interest.