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Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study

Abstract: We aim to evaluate the epidemiology and outcome of gram-negative prosthetic joint infection (GN-PJI) treated with debridement, antibiotics and implant retention (DAIR), identify factors predictive of failure, and determine the impact of ciprofloxacin use on prognosis. We performed a retrospective, multicentre, observational study of GN-PJI diagnosed from 2003 through to 2010 in 16 Spanish hospitals. We define failure as persistence or reappearance of the inflammatory joint signs during follow-up, leading to unplanned surgery or repeat debridement>30 days from the index surgery related death, or suppressive antimicrobial therapy. Parameters predicting failure were analysed with a Cox regression model. A total of 242 patients (33% men; median age 76 years, interquartile range (IQR) 68-81) with 242 episodes of GN-PJI were studied. The implants included 150 (62%) hip, 85 (35%) knee, five (2%) shoulder and two (1%) elbow prostheses. There were 189 (78%) acute infections. Causative microorganisms were Enterobacteriaceae in 78%, Pseudomonas spp. in 20%, and other gram-negative bacilli in 2%. Overall, 19% of isolates were ciprofloxacin resistant. DAIR was used in 174 (72%) cases, with an overall success rate of 68%, which increased to 79% after a median of 25 months' follow-up in ciprofloxacin-susceptible GN-PJIs treated with ciprofloxacin. Ciprofloxacin treatment exhibited an independent protective effect (adjusted hazard ratio (aHR) 0.23; 95% CI, 0.13-0.40; p<0.001), whereas chronic renal impairment predicted failure (aHR, 2.56; 95% CI, 1.14-5.77; p 0.0232). Our results confirm a 79% success rate in ciprofloxacin-susceptible GN-PJI treated with debridement, ciprofloxacin and implant retention. New therapeutic strategies are needed for ciprofloxacin-resistant PJI.

 Fuente: Clinical Microbiology and Infection, 2014, 20(11), 911-919

 Editorial: Elsevier

 Año de publicación: 2014

 Nº de páginas: 9

 Tipo de publicación: Artículo de Revista

 DOI: 10.1111/1469-0691.12649

 ISSN: 1198-743X,1469-0691

 Url de la publicación: https://doi.org/10.1111/1469-0691.12649

Autoría

RODRÍGUEZ-PARDO, D.

PIGRAU, C.

LORA-TAMAYO, J.

SORIANO, A.

DEL TORO, M.D.

COBO, J.

PALOMINO, J.

EUBA, G.

RIERA, M.

SÁNCHEZ-SOMOLINOS, M.

SORLI, L.

GUIO, L.

IRIBARREN, J.A.

BARAIA-ETXABURU, J.M.

RAMOS, A.

BAHAMONDE, A.

FLORES-SÁNCHEZ, X.

CORONA, P.S.