Multidrug-resistant and extensively drug-resistant Gram-negative prosthetic joint infections: Role of surgery and impact of colistin administration
Por:
Papadopoulos, A, Ribera, A, Mavrogenis, AF, Rodriguez-Pardo, D, Bonnet, E, Salles, MJ, del Toro, MD, Nguyen, S, Blanco-Garcia, A, Skaliczki, G, Soriano, A, Benito, N, Petersdorf, S, Pasticci, MB, Tattevin, P, Tufan, ZK, Chan, M, O'Connell, N, Pantazis, N, Kyprianou, A, Pigrau, C, Megaloikonomos, PD, Senneville, E, Ariza, J, Papagelopoulos, PJ, Giannitsioti, E, Esteban-Moreno, J, Parron, R, Lye, D, Guner, R, Morata, L, Munoz-Mahamud, E, Lozano, L, Los-Arcos, I, Corona, PS, Lung, M, Ribeiro, TC, Klautau, GB, Cardaci, S, Izquierdo, YB, Mur, I, Crusi, X, Jordan, M, Gonzalez, JC, Coll, P, Rivera, A, Gheno, M, Ouamara-Digue, E, Jolivet-Gougeon, A, Arvieux, C, Prinz, G, Lakatos, B, Antonakos, N, Siakalis, G, Dourou, A, Aggelou, E, Nikou, P, Athanasia, S, Igoumenou, VG
Publicada:
1 mar 2019
Resumen:
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 (20 0 0-2015) 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), fluoroquinoloneresistant (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. (c) 2018 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.
Filiaciones:
Papadopoulos, A:
Univ Athens, Sch Med, Univ Gen Hosp ATTIKON, Dept Internal Med 4, Athens, Greece
Ribera, A:
Hosp Univ Bellvitge, Dept Infect Dis, Barcelona, Spain
Mavrogenis, AF:
Univ Athens, Sch Med, Univ Gen Hosp ATTIKON, Dept Orthopaed 1, Athens, Greece
Rodriguez-Pardo, D:
Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain
Bonnet, E:
Hop Joseph Ducuing, Dept Infect Dis, Toulouse, France
Salles, MJ:
Santa Casa Sao Paulo Sch Med Sci, Dept Internal Med, Div Infect Dis, Sao Paulo, Brazil
del Toro, MD:
Univ Seville, Hosp Univ Virgen Macarena, Inst Biomed Sevilla IBIS, Infect Dis Unit, Seville, Spain
Nguyen, S:
Gustave Dron Hosp, Dept Infect Dis, Tourcoing, France
Blanco-Garcia, A:
IIS Fdn Jimenez Diaz Hosp, Dept Emergency Med, Bone & Joint Infect Unit, Madrid, Spain
Skaliczki, G:
Semmelweis Univ, Dept Orthopaed, Budapest, Hungary
Soriano, A:
Univ Barcelona, Hosp Clin, IDIBAPS, Dept Infect Dis, Barcelona, Spain
Benito, N:
Univ Autonoma Barcelona, Inst Invest Biomed St Pau, Hosp Santa Creu & St Pau, Unit Infect Dis,Dept Internal Med, Barcelona, Spain
Petersdorf, S:
Heinrich Heine Univ, Univ Hosp, Inst Med Microbiol & Hosp Hyg, Dusseldorf, Germany
Pasticci, MB:
Univ Perugia, Infect Dis Unit, Perugia, Italy
Tattevin, P:
Pontchaillou Univ Hosp, Infect Dis & Intens Care Unit, Rennes, France
Tufan, ZK:
Yildirim Beyazit Univ, Ankara Ataturk Educ & Res Hosp, Fac Med, Dept Infect Dis & Clin Microbiol, Ankara, Turkey
Chan, M:
Tan Tock Seng Hosp, Inst Infect Dis & Epidemiol, Dept Infect Dis, Singapore, Singapore
O'Connell, N:
Univ Hosp Limerick, Dept Clin Microbiol, Limerick, Ireland
Pantazis, N:
Univ Athens, Sch Med, Dept Hyg Epidemiol & Med Stat, Athens, Greece
Kyprianou, A:
Univ Athens, Sch Med, Univ Gen Hosp ATTIKON, Dept Internal Med 4, Athens, Greece
Pigrau, C:
Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain
Megaloikonomos, PD:
Univ Athens, Sch Med, Univ Gen Hosp ATTIKON, Dept Orthopaed 1, Athens, Greece
Senneville, E:
Gustave Dron Hosp, Dept Infect Dis, Tourcoing, France
Ariza, J:
Hosp Univ Bellvitge, Dept Infect Dis, Barcelona, Spain
Papagelopoulos, PJ:
Univ Athens, Sch Med, Univ Gen Hosp ATTIKON, Dept Orthopaed 1, Athens, Greece
Giannitsioti, E:
Univ Athens, Sch Med, Univ Gen Hosp ATTIKON, Dept Internal Med 4, Athens, Greece
Esteban-Moreno, J:
IIS Fdn Jimenez Diaz, Dept Clin Microbiol, Madrid, Spain
IIS Fdn Jimenez Diaz, Bone & Joint Infect Unit, Madrid, Spain
Parron, R:
IIS Fdn Jimenez Diaz Hosp, Dept Emergency Med, Bone & Joint Infect Unit, Madrid, Spain
Lye, D:
Tan Tock Seng Hosp, Inst Infect Dis & Epidemiol, Dept Infect Dis, Singapore, Singapore
Guner, R:
Yildirim Beyazit Univ, Ankara Ataturk Educ & Res Hosp, Fac Med, Dept Infect Dis & Clin Microbiol, Ankara, Turkey
Morata, L:
Hosp Clin Barcelona, Dept Infect Dis, Barcelona, Spain
Munoz-Mahamud, E:
Hosp Clin Barcelona, Dept Orthoped, Barcelona, Spain
Lozano, L:
Hosp Clin Barcelona, Dept Orthoped, Barcelona, Spain
Los-Arcos, I:
Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain
Corona, PS:
Hosp Univ Vall dHebron, Dept Orthoped Surg, Reconstruct Surg & Sept Div, Barcelona, Spain
Lung, M:
Hosp Univ Vall dHebron, Dept Microbiol, Barcelona, Spain
Ribeiro, TC:
Santa Casa Sao Paulo Sch Med Sci, Dept Internal Med, Div Infect Dis, Sao Paulo, Brazil
Klautau, GB:
Santa Casa Sao Paulo Sch Med Sci, Dept Internal Med, Div Infect Dis, Sao Paulo, Brazil
Cardaci, S:
Univ Perugia, Infect Dis Unit, Perugia, Italy
Izquierdo, YB:
Hosp Univ Virgen Macarena, Infect Dis Unit, Seville, Spain
Mur, I:
Univ Autonoma Barcelona, Inst Invest Biomed St Pau, Hosp Santa Creu & St Pau, Unit Infect Dis,Dept Internal Med, Barcelona, Spain
Crusi, X:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau, Dept Orthoped, Barcelona, Spain
Jordan, M:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau, Dept Orthoped, Barcelona, Spain
Gonzalez, JC:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau, Dept Orthoped, Barcelona, Spain
Coll, P:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau, Dept Clin Microbiol, Barcelona, Spain
Rivera, A:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau, Dept Clin Microbiol, Barcelona, Spain
Gheno, M:
Pontchaillou Univ Hosp, Infect Dis & Intens Care Unit, Rennes, France
Ouamara-Digue, E:
Pontchaillou Univ Hosp, Infect Dis & Intens Care Unit, Rennes, France
Jolivet-Gougeon, A:
Pontchaillou Univ Hosp, Infect Dis & Intens Care Unit, Rennes, France
Arvieux, C:
Pontchaillou Univ Hosp, Infect Dis & Intens Care Unit, Rennes, France
Prinz, G:
Joined St Stephan & St Ladislaus Hosp, Dept Internal Med 1, Budapest, Hungary
Lakatos, B:
Joined St Stephan & St Ladislaus Hosp, Dept Infect Dis, Budapest, Hungary
Antonakos, N:
Univ Athens, Sch Med, Univ Gen Hosp ATTIKON, Dept Internal Med 4, Athens, Greece
Siakalis, G:
Univ Athens, Sch Med, Univ Gen Hosp ATTIKON, Dept Internal Med 4, Athens, Greece
Dourou, A:
Univ Athens, Sch Med, Univ Gen Hosp ATTIKON, Dept Internal Med 4, Athens, Greece
Aggelou, E:
Univ Athens, Sch Med, Univ Gen Hosp ATTIKON, Dept Internal Med 4, Athens, Greece
Nikou, P:
Univ Athens, Sch Med, Univ Gen Hosp ATTIKON, Dept Internal Med 4, Athens, Greece
Athanasia, S:
Univ Athens, Sch Med, Univ Gen Hosp ATTIKON, Dept Internal Med 4, Athens, Greece
Igoumenou, VG:
Univ Athens, Sch Med, Univ Gen Hosp ATTIKON, Dept Orthopaed 1, Athens, Greece
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