A Large Multicenter Study of Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus Prosthetic Joint Infections Managed With Implant Retention
Por:
Lora-Tamayo, J, Murillo, O, Iribarren, JA, Soriano, A, Sanchez-Somolinos, M, Baraia-Etxaburu, JM, Rico, A, Palomino, J, Rodriguez-Pardo, D, Horcajada, JP, Benito, N, Bahamonde, A, Granados, A, del Toro, MD, Cobo, J, Riera, M, Ramos, A, Jover-Saenz, A, Ariza, J
Publicada:
15 ene 2013
Resumen:
Background. Several series predicting the prognosis of staphylococcal prosthetic joint infection (PJI) managed with debridement, antibiotics, and implant retention (DAIR) have been published, but some of their conclusions are controversial. At present, little is known regarding the efficacy of the different antibiotics that are used or their ability to eliminate methicillin-resistant S. aureus (MRSA) infection.
Methods. This was a retrospective, multicenter, observational study of cases of PJI by S. aureus that were managed with DAIR (2003-2010). Cases were classified as failures when infection persistence/relapse, death, need for salvage therapy, or prosthesis removal occurred. The parameters that predicted failure were analyzed with logistic and Cox regression.
Results. Out of 345 episodes (41% men, 73 years), 81 episodes were caused by MRSA. Fifty-two were hematogenous, with poorer prognoses, and 88% were caused by methicillin-susceptible S. aureus (MSSA). Antibiotics were used for a median of 93 days, with similar use of rifampin-based combinations in MSSA- and MRSA-PJI. Failure occurred in 45% of episodes, often early after debridement. The median survival time was 1257 days. There were no overall prognostic differences between MSSA- and MRSA-PJI, but there was a higher incidence of MRSA-PJI treatment failure during the period of treatment (HR 2.34), while there was a higher incidence of MSSA-PJI treatment failure after therapy. Rifampin-based combinations exhibited an independent protective effect. Other independent predictors of outcome were polymicrobial, inflammatory, and bacteremic infections requiring more than 1 debridement, immunosuppressive therapy, and the exchange of removable components of the prosthesis.
Conclusions. This is the largest series of PJI by S. aureus managed with DAIR reported to date. The success rate was 55%. The use of rifampin may have contributed to homogenizing MSSA and MRSA prognoses, although the specific rifampin combinations may have had different efficacies.
Filiaciones:
Lora-Tamayo, J:
Univ Barcelona, Hosp Univ Bellvitge, IDIBELL, Dept Infect Dis, Barcelona 08907, Spain
Iribarren, JA:
Hosp Univ Donostia, Dept Infect Dis, San Sebastian, Spain
Soriano, A:
Hosp Clin Barcelona, Dept Infect Dis, Barcelona, Spain
Sanchez-Somolinos, M:
Hosp Gen Univ Gregorio Maranon, Dept Microbiol & Infect Dis, Madrid, Spain
Baraia-Etxaburu, JM:
Hosp Basurto, Dept Infect Dis, Bilbao, Spain
Rico, A:
Hosp Univ La Paz, Unit Infect Dis, Madrid, Spain
Palomino, J:
Hosp Univ Virgen del Rocio, Dept Infect Dis, Seville, Spain
Rodriguez-Pardo, D:
Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain
Horcajada, JP:
Hosp del Mar, Dept Internal Med & Infect Dis, Barcelona, Spain
Benito, N:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Internal Med, Unit Infect Dis, E-08193 Barcelona, Spain
Bahamonde, A:
Hosp El Bierzo, Dept Internal Med, Ponferrada, Spain
Granados, A:
Consorcio Sanitario Parc Tauli, Dept Infect Dis, Sabadell, Spain
del Toro, MD:
Hosp Univ Virgen Macarena, Dept Infect Dis, Seville, Spain
Cobo, J:
Hosp Basurto, Dept Infect Dis, Bilbao, Spain
Riera, M:
Hosp Univ Son Espases, Dept Internal Med, Unit Infect Dis, Palma De Mallorca, Spain
Ramos, A:
Hosp Univ Puerta de Hierro, Dept Internal Med, Unit Infect Dis, Madrid, Spain
Jover-Saenz, A:
Hosp Arnau Vilanova, Unit Nosocomial Infect, Lerida, Spain
Hosp Univ Ramon & Cajal, Dept Infect Dis, Madrid, Spain.
Bronze, Green Published
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