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

D. Rodríguez-Pardo, C. Pigrau, J. Lora-Tamayo, A. Soriano, M. D. del Toro, J. Cobo, J. Palomino, G. Euba, M. Riera, M. Sánchez-Somolinos, N. Benito, M. Fernández-Sampedro, L. Sorli, L. Guio, J. A. Iribarren, J. M. Baraia-Etxaburu, A. Ramos, A. Bahamonde, X. Flores-Sánchez, P. S. CoronaJ. Ariza, Carles Amat, M. Nieves Larrosa, Mireia Puig, Oscar Murillo, Xavier Cabo, Miguel Ángel Goenaga, Maitane Elola, Gaspar De la Herrán, José Ma Garcia-Arenzana, Sebastián García-Ramiro, Juan Carlos Martínez-Pastor, Eduard Tornero, Juan Manuel García-Lechuz, Mercedes Marín, Manuel Villanueva, Inigo López, Ramón Cisterna, Juan Miguel Santamaría, María José Gómez, Andrés Puente, Pedro Cano, Juan Pablo Horcajada, Paula González-Mínguez, Eugenia Portillo, Lluis Puig, María Franco, Marcos Jordán, Pere Coll, Juan Amador-Mellado, Carlos Fuster-Foz, Luis García-Paíno, Isabel Nieto, Miguel Ángel Muniain, Ana Isabel Suárez, Julia Praena, María José Gómez, Andrés Puente, María Antonia Maseguer, Eduardo Garagorri, Vicente Pintado, Carmen Marinescu, Antonio Ramírez, Francisco Montaner, Elena Múñez, Teresa Álvarez, Rodrigo García, Elena Puente, Carlos Salas, María Carmen Fariñas, Josu Merino Pérez, Begoña Vilar Achabal, José Miguel Montejo Baranda

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Abstract

© 2014 European Society of Clinical Microbiology and Infectious Diseases. 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.
Original languageEnglish
Pages (from-to)O911-O919
JournalClinical Microbiology and Infection
Volume20
Issue number11
DOIs
Publication statusPublished - 1 Nov 2014

Keywords

  • Ciprofloxacin
  • Debridement
  • Gram-negative bacteria
  • Prognosis
  • Prosthetic joint infection

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    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., ... Montejo Baranda, J. M. (2014). Gram-negative prosthetic joint infection: Outcome of a debridement, antibiotics and implant retention approach. A large multicentre study. Clinical Microbiology and Infection, 20(11), O911-O919. https://doi.org/10.1111/1469-0691.12649