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 - Amat, Carles
AU - Larrosa, M. Nieves
AU - Puig, Mireia
AU - Murillo, Oscar
AU - Cabo, Xavier
AU - Goenaga, Miguel Ángel
AU - Elola, Maitane
AU - De la Herrán, Gaspar
AU - Garcia-Arenzana, José Ma
AU - García-Ramiro, Sebastián
AU - Martínez-Pastor, Juan Carlos
AU - Tornero, Eduard
AU - García-Lechuz, Juan Manuel
AU - Marín, Mercedes
AU - Villanueva, Manuel
AU - López, Inigo
AU - Cisterna, Ramón
AU - Santamaría, Juan Miguel
AU - Gómez, María José
AU - Puente, Andrés
AU - Cano, Pedro
AU - Horcajada, Juan Pablo
AU - González-Mínguez, Paula
AU - Portillo, Eugenia
AU - Puig, Lluis
AU - Franco, María
AU - Jordán, Marcos
AU - Coll, Pere
AU - Amador-Mellado, Juan
AU - Fuster-Foz, Carlos
AU - García-Paíno, Luis
AU - Nieto, Isabel
AU - Muniain, Miguel Ángel
AU - Suárez, Ana Isabel
AU - Praena, Julia
AU - Gómez, María José
AU - Puente, Andrés
AU - Maseguer, María Antonia
AU - Garagorri, Eduardo
AU - Pintado, Vicente
AU - Marinescu, Carmen
AU - Ramírez, Antonio
AU - Montaner, Francisco
AU - Múñez, Elena
AU - Álvarez, Teresa
AU - García, Rodrigo
AU - Puente, Elena
AU - Salas, Carlos
AU - Fariñas, María Carmen
AU - Pérez, Josu Merino
AU - Achabal, Begoña Vilar
AU - Montejo Baranda, José Miguel
PY - 2014/11/1
Y1 - 2014/11/1
N2 - © 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.
AB - © 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.
KW - Ciprofloxacin
KW - Debridement
KW - Gram-negative bacteria
KW - Prognosis
KW - Prosthetic joint infection
U2 - 10.1111/1469-0691.12649
DO - 10.1111/1469-0691.12649
M3 - Article
VL - 20
SP - O911-O919
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
SN - 1198-743X
IS - 11
ER -
