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A large multicenter study of methicillin-susceptible and methicillin-resistant Staphylococcus aureus prosthetic joint infections managed with implant retention.
Clin Infect Dis 2013; 56(2):182-94CI

Abstract

BACKGROUND

Several series predicting the prognosis of staphylococcal prosthetic joint infection (PJI) managed with debridement, antibiotics, and implant retention (DAIR) have been published, but some of their conclusions are controversial. At present, little is known regarding the efficacy of the different antibiotics that are used or their ability to eliminate methicillin-resistant S. aureus (MRSA) infection.

METHODS

This was a retrospective, multicenter, observational study of cases of PJI by S. aureus that were managed with DAIR (2003-2010). Cases were classified as failures when infection persistence/relapse, death, need for salvage therapy, or prosthesis removal occurred. The parameters that predicted failure were analyzed with logistic and Cox regression.

RESULTS

Out of 345 episodes (41% men, 73 years), 81 episodes were caused by MRSA. Fifty-two were hematogenous, with poorer prognoses, and 88% were caused by methicillin-susceptible S. aureus (MSSA). Antibiotics were used for a median of 93 days, with similar use of rifampin-based combinations in MSSA- and MRSA-PJI. Failure occurred in 45% of episodes, often early after debridement. The median survival time was 1257 days. There were no overall prognostic differences between MSSA- and MRSA-PJI, but there was a higher incidence of MRSA-PJI treatment failure during the period of treatment (HR 2.34), while there was a higher incidence of MSSA-PJI treatment failure after therapy. Rifampin-based combinations exhibited an independent protective effect. Other independent predictors of outcome were polymicrobial, inflammatory, and bacteremic infections requiring more than 1 debridement, immunosuppressive therapy, and the exchange of removable components of the prosthesis.

CONCLUSIONS

This is the largest series of PJI by S. aureus managed with DAIR reported to date. The success rate was 55%. The use of rifampin may have contributed to homogenizing MSSA and MRSA prognoses, although the specific rifampin combinations may have had different efficacies.

Authors+Show Affiliations

Infectious Diseases, Hospital Universitario Bellvitge, IDIBELL, Universidad de Barcelona, Barcelona, Spain. jaime@lora-tamayo.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22942204

Citation

Lora-Tamayo, Jaime, et al. "A Large Multicenter Study of Methicillin-susceptible and Methicillin-resistant Staphylococcus Aureus Prosthetic Joint Infections Managed With Implant Retention." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 56, no. 2, 2013, pp. 182-94.
Lora-Tamayo J, Murillo O, Iribarren JA, et al. A large multicenter study of methicillin-susceptible and methicillin-resistant Staphylococcus aureus prosthetic joint infections managed with implant retention. Clin Infect Dis. 2013;56(2):182-94.
Lora-Tamayo, J., Murillo, O., Iribarren, J. A., Soriano, A., Sánchez-Somolinos, M., Baraia-Etxaburu, J. M., ... Ariza, J. (2013). A large multicenter study of methicillin-susceptible and methicillin-resistant Staphylococcus aureus prosthetic joint infections managed with implant retention. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 56(2), pp. 182-94. doi:10.1093/cid/cis746.
Lora-Tamayo J, et al. A Large Multicenter Study of Methicillin-susceptible and Methicillin-resistant Staphylococcus Aureus Prosthetic Joint Infections Managed With Implant Retention. Clin Infect Dis. 2013;56(2):182-94. PubMed PMID: 22942204.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A large multicenter study of methicillin-susceptible and methicillin-resistant Staphylococcus aureus prosthetic joint infections managed with implant retention. AU - Lora-Tamayo,Jaime, AU - Murillo,Oscar, AU - Iribarren,José Antonio, AU - Soriano,Alex, AU - Sánchez-Somolinos,Mar, AU - Baraia-Etxaburu,Josu Miren, AU - Rico,Alicia, AU - Palomino,Julián, AU - Rodríguez-Pardo,Dolors, AU - Horcajada,Juan Pablo, AU - Benito,Natividad, AU - Bahamonde,Alberto, AU - Granados,Ana, AU - del Toro,María Dolores, AU - Cobo,Javier, AU - Riera,Melchor, AU - Ramos,Antonio, AU - Jover-Sáenz,Alfredo, AU - Ariza,Javier, AU - ,, Y1 - 2012/08/31/ PY - 2012/9/4/entrez PY - 2012/9/4/pubmed PY - 2013/6/12/medline SP - 182 EP - 94 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 56 IS - 2 N2 - BACKGROUND: Several series predicting the prognosis of staphylococcal prosthetic joint infection (PJI) managed with debridement, antibiotics, and implant retention (DAIR) have been published, but some of their conclusions are controversial. At present, little is known regarding the efficacy of the different antibiotics that are used or their ability to eliminate methicillin-resistant S. aureus (MRSA) infection. METHODS: This was a retrospective, multicenter, observational study of cases of PJI by S. aureus that were managed with DAIR (2003-2010). Cases were classified as failures when infection persistence/relapse, death, need for salvage therapy, or prosthesis removal occurred. The parameters that predicted failure were analyzed with logistic and Cox regression. RESULTS: Out of 345 episodes (41% men, 73 years), 81 episodes were caused by MRSA. Fifty-two were hematogenous, with poorer prognoses, and 88% were caused by methicillin-susceptible S. aureus (MSSA). Antibiotics were used for a median of 93 days, with similar use of rifampin-based combinations in MSSA- and MRSA-PJI. Failure occurred in 45% of episodes, often early after debridement. The median survival time was 1257 days. There were no overall prognostic differences between MSSA- and MRSA-PJI, but there was a higher incidence of MRSA-PJI treatment failure during the period of treatment (HR 2.34), while there was a higher incidence of MSSA-PJI treatment failure after therapy. Rifampin-based combinations exhibited an independent protective effect. Other independent predictors of outcome were polymicrobial, inflammatory, and bacteremic infections requiring more than 1 debridement, immunosuppressive therapy, and the exchange of removable components of the prosthesis. CONCLUSIONS: This is the largest series of PJI by S. aureus managed with DAIR reported to date. The success rate was 55%. The use of rifampin may have contributed to homogenizing MSSA and MRSA prognoses, although the specific rifampin combinations may have had different efficacies. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/22942204/A_large_multicenter_study_of_methicillin_susceptible_and_methicillin_resistant_Staphylococcus_aureus_prosthetic_joint_infections_managed_with_implant_retention_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cis746 DB - PRIME DP - Unbound Medicine ER -