Implant Removal in the Management of Prosthetic Joint Infection by <i>Staphylococcus aureus</i>: Outcome and Predictors of Failure in a Large Retrospective Multicenter Study

Joan Gómez-Junyent, Jaime Lora-Tamayo, Josu Baraia-Etxaburu, Mar Sánchez-Somolinos, Jose Antonio Iribarren, Dolors Rodriguez-Pardo, Julia Praena-Segovia, Luisa Sorlí, Alberto Bahamonde, Melchor Riera, Alicia Rico, María Dolores del Toro López, Laura Morata, Javier Cobo, Luis Falgueras, Natividad Benito, Elena Muñez Rubio, Alfredo Jover-Sáenz, Carles Pigrau, Javier ArizaOscar Murillo

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives: To compare the characteristics and outcomes of cases with acute prosthetic joint infection (PJI; early post-surgical or hematogenous) by Staphylococcus aureus managed with implant removal (IRm) or debridement and retention (DAIR). To analyze the outcomes of all cases managed with IRm (initially or after DAIR failure). Methods: Retrospective, multicenter, cohort study of PJI by S. aureus (2003–2010). Overall failure included mortality within 60 days since surgery and local failure due to staphylococcal persistence/relapse. Results: 499 cases, 338 initially managed with DAIR, 161 with IRm. Mortality was higher in acute PJI managed initially with IRm compared to DAIR, but not associated with the surgical procedure, after propensity score matching. Underlying conditions, hemiarthroplasty, and methicillin-resistant S. aureus were risk factors for mortality. Finally, 249 cases underwent IRm (88 after DAIR failure); overall failure was 15.6%. Local failure (9.3%) was slightly higher in cases with several comorbidities, but independent of previous DAIR, type of IRm, and rifampin treatment. Conclusions: In a large multicenter study of S. aureus PJI managed with IRm, failure was low, but mortality significant, especially in cases with acute PJI and underlying conditions, but not associated with the IRm itself. Rifampin efficacy was limited in this setting.

Original languageEnglish
Article number118
Pages (from-to)1-13
Number of pages13
JournalAntibiotics
Volume10
Issue number2
DOIs
Publication statusPublished - 26 Jan 2021

Keywords

  • Implant removal
  • Outcome
  • Prosthetic joint infection
  • Rifampin
  • Staphylococcus aureus
  • rifampin
  • implant removal
  • outcome
  • prosthetic joint infection

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