Multidrug-resistant and extensively drug-resistant Gram-negative prosthetic joint infections: Role of surgery and impact of colistin administration

Antonios Papadopoulos, Alba Ribera, Andreas F. Mavrogenis, Dolors Rodriguez-Pardo, Eric Bonnet, Mauro José Salles, María Dolores del Toro, Sophie Nguyen, Antonio Blanco-García, Gábor Skaliczki, Alejandro Soriano, Natividad Benito, Sabine Petersdorf, Maria Bruna Pasticci, Pierre Tattevin, Zeliha Kocak Tufan, Monica Chan, Nuala O'Connell, Nikos Pantazis, Aikaterini KyprianouCarlos Pigrau, Panayiotis D. Megaloikonomos, Eric Senneville, Javier Ariza, Panayiotis J. Papagelopoulos, Efthymia Giannitsioti

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    24 Citations (Scopus)


    © 2019 Elsevier Ltd Factors influencing treatment outcome of patients with Gram-negative bacterial (GNB) multidrug-resistant (MDR) and extensively drug-resistant (XDR) prosthetic joint infection (PJIs) were analysed. Data were collected (2000–2015) by 18 centres. Treatment success was analysed by surgery type for PJI, resistance (MDR/XDR) and antimicrobials (colistin/non-colistin) using logistic regression and survival analyses. A total of 131 patients (mean age 73.0 years, 35.9% male, 58.8% with co-morbidities) with MDR (n = 108) or XDR (n = 23) GNB PJI were assessed. The most common pathogens were Escherichia coli (33.6%), Pseudomonas aeruginosa (25.2%), Klebsiella pneumoniae (21.4%) and Enterobacter cloacae (17.6%). Pseudomonas aeruginosa predominated in XDR cases. Isolates were carbapenem-resistant (n = 12), fluoroquinolone-resistant (n = 63) and ESBL-producers (n = 94). Treatment outcome was worse in XDR versus MDR cases (P = 0.018). Success rates did not differ for colistin versus non-colistin in XDR cases (P = 0.657), but colistin was less successful in MDR cases (P = 0.018). Debridement, antibiotics and implant retention (DAIR) (n = 67) was associated with higher failure rates versus non-DAIR (n = 64) (OR = 3.57, 95% CI 1.68–7.58; P < 0.001). Superiority of non-DAIR was confirmed by Kaplan–Meir analysis (HR = 0.36, 95% CI 0.20–0.67) and remained unchangeable by time of infection (early/late), antimicrobial resistance (MDR/XDR) and antimicrobials (colistin/non-colistin) (Breslow–Day, P = 0.737). DAIR is associated with higher failure rates even in early MDR/XDR GNB PJIs versus implant removal. Colistin should be preserved for XDR cases as it is detrimental in MDR infections.
    Original languageEnglish
    Pages (from-to)294-301
    JournalInternational Journal of Antimicrobial Agents
    Publication statusPublished - 1 Mar 2019


    • Bone, joint infection
    • Extensively drug resistant
    • Gram negative bacteria
    • Multidrug resistant
    • Prosthetic joint infection


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