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Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study.
Clin Microbiol Infect 2014; 20(11):O911-9CM

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.

Authors+Show Affiliations

Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.No 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 availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

24766536

Citation

Rodríguez-Pardo, D, et al. "Gram-negative Prosthetic Joint Infection: Outcome of a Debridement, Antibiotics and Implant Retention Approach. a Large Multicentre Study." Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, vol. 20, no. 11, 2014, pp. O911-9.
Rodríguez-Pardo D, Pigrau C, Lora-Tamayo J, et al. Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study. Clin Microbiol Infect. 2014;20(11):O911-9.
Rodríguez-Pardo, D., Pigrau, C., Lora-Tamayo, J., Soriano, A., del Toro, M. D., Cobo, J., ... Ariza, J. (2014). Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study. Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, 20(11), pp. O911-9. doi:10.1111/1469-0691.12649.
Rodríguez-Pardo D, et al. Gram-negative Prosthetic Joint Infection: Outcome of a Debridement, Antibiotics and Implant Retention Approach. a Large Multicentre Study. Clin Microbiol Infect. 2014;20(11):O911-9. PubMed PMID: 24766536.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study. AU - Rodríguez-Pardo,D, AU - Pigrau,C, AU - Lora-Tamayo,J, AU - Soriano,A, AU - del Toro,M D, AU - Cobo,J, AU - Palomino,J, AU - Euba,G, AU - Riera,M, AU - Sánchez-Somolinos,M, AU - Benito,N, AU - Fernández-Sampedro,M, AU - Sorli,L, AU - Guio,L, AU - Iribarren,J A, AU - Baraia-Etxaburu,J M, AU - Ramos,A, AU - Bahamonde,A, AU - Flores-Sánchez,X, AU - Corona,P S, AU - Ariza,J, AU - ,, Y1 - 2014/06/14/ PY - 2014/02/02/received PY - 2014/04/07/revised PY - 2014/04/18/accepted PY - 2014/4/29/entrez PY - 2014/4/29/pubmed PY - 2015/8/5/medline KW - Ciprofloxacin KW - debridement KW - gram-negative bacteria KW - prognosis KW - prosthetic joint infection SP - O911 EP - 9 JF - Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases JO - Clin. Microbiol. Infect. VL - 20 IS - 11 N2 - 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. SN - 1469-0691 UR - https://www.unboundmedicine.com/medline/citation/24766536/Gram_negative_prosthetic_joint_infection:_outcome_of_a_debridement_antibiotics_and_implant_retention_approach__A_large_multicentre_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1198-743X(14)65347-7 DB - PRIME DP - Unbound Medicine ER -