Gram‐negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study. (14th June 2014)

• Record Type: Journal Article
• Authors: 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.; Benito, N.; Fernández‐Sampedro, M.; Sorli, L.; Guio, L.; Iribarren, J. A.; Baraia‐Etxaburu, J. M.; Ramos, A.; Bahamonde, A.; Flores‐Sánchez, X.; Corona, P. S.; Ariza, J.; the REIPI Group for the Study of Prosthetic Infection; Rolain, J.‐M.
• Is Part Of: Clinical microbiology and infection. Volume 20:Number 11(2014:Nov.)
• Page Start: O911
• Page End: O919
• Publication Date: 2014-06-14
• Subjects: Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1111/1469-0691.12649
• Languages: English
• ISSNs: 1198-743X

Abstract

<abstract abstract-type="main" id="clm12649-abs-0001"> <title>Abstract</title> <p>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%, <italic>Pseudomonas</italic> 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<italic> </italic><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.</p> </abstract>