TY - JOUR
T1 - The not-so-good prognosis of streptococcal periprosthetic joint infection managed by implant retention
T2 - The results of a large multicenter study
AU - Lora-Tamayo, Jaime
AU - Senneville, Éric
AU - Ribera, Alba
AU - Bernard, Louis
AU - Dupon, Michel
AU - Zeller, Valérie
AU - Li, Ho Kwong
AU - Arvieux, Cédric
AU - Clauss, Martin
AU - Uçkay, Ilker
AU - Vigante, Dace
AU - Ferry, Tristan
AU - Iribarren, José Antonio
AU - Peel, Trisha N.
AU - Sendi, Parham
AU - Miksić, Nina Gorišek
AU - Rodríguez-Pardo, Dolors
AU - Del Toro, María Dolores
AU - Fernández-Sampedro, Marta
AU - Dapunt, Ulrike
AU - Huotari, Kaisa
AU - Davis, Joshua S.
AU - Palomino, Julián
AU - Neut, Danielle
AU - Clark, Benjamin M.
AU - Gottlieb, Thomas
AU - Trebše, Rihard
AU - Soriano, Alex
AU - Bahamonde, Alberto
AU - Guío, Laura
AU - Rico, Alicia
AU - Salles, Mauro J.C.
AU - Pais, M. José G.
AU - Benito, Natividad
AU - Riera, Melchor
AU - Gómez, Lucía
AU - Aboltins, Craig A.
AU - Esteban, Jaime
AU - Horcajada, Juan Pablo
AU - O'connell, Karina
AU - Ferrari, Matteo
AU - Skaliczki, Gábor
AU - Juan, Rafael San
AU - Cobo, Javier
AU - Sánchez-Somolinos, Mar
AU - Ramos, Antonio
AU - Giannitsioti, Efthymia
AU - Jover-Sáenz, Alfredo
AU - Baraia-Etxaburu, Josu Mirena
AU - Barbero, José María
AU - Choong, Peter F.M.
AU - Asseray, Nathalie
AU - Ansart, Séverine
AU - Moal, Gwenäel Le
AU - Zimmerli, Werner
AU - Ariza, Javier
AU - for the Group of Investigators for Streptococcal Prosthetic Joint Infection
PY - 2017/6/15
Y1 - 2017/6/15
N2 - Background. Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success. Methods. A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy. Results. Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: Failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34). Conclusions. This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rifampin.
AB - Background. Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success. Methods. A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy. Results. Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: Failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34). Conclusions. This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rifampin.
KW - biofilm
KW - bone and joint infection
KW - DAIR
KW - rifampin.
UR - http://www.scopus.com/inward/record.url?scp=85021164968&partnerID=8YFLogxK
U2 - 10.1093/cid/cix227
DO - 10.1093/cid/cix227
M3 - Article
AN - SCOPUS:85021164968
SN - 1058-4838
VL - 64
SP - 1742
EP - 1752
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 12
ER -