A large multicenter study of methicillin-susceptible and methicillin-resistant staphylococcus aureus prosthetic joint infections managed with implant retention

Jaime Lora-Tamayo, Oscar Murillo, José Antonio Iribarren, Alex Soriano, Mar Sánchez-Somolinos, Josu Miren Baraia-Etxaburu, Alicia Rico, Julián Palomino, Dolors Rodríguez-Pardo, Juan Pablo Horcajada, Natividad Benito, Alberto Bahamonde, Ana Granados, María Dolores Del Toro, Javier Cobo, Melchor Riera, Antonio Ramos, Alfredo Jover-Sáenz, Javier Ariza

Research output: Contribution to journalArticleResearchpeer-review

194 Citations (Scopus)

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. © 2012 The Author. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
Original languageEnglish
Pages (from-to)182-194
JournalClinical Infectious Diseases
Volume56
Issue number2
DOIs
Publication statusPublished - 15 Jan 2013

Keywords

  • antibiotics and implant retention (DAIR)
  • MRSA
  • prosthetic joint infection
  • rifampin
  • Staphylococcus aureus

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