1
|
Lora-Tamayo J, Senneville É, Ribera A, Bernard L, Dupon M, Zeller V, Li HK, Arvieux C, Clauss M, Uçkay I, Vigante D, Ferry T, Iribarren JA, Peel TN, Sendi P, Miksic NG, Rodríguez-Pardo D, Del Toro MD, Fernández-Sampedro M, Dapunt U, Huotari K, Davis JS, Palomino J, Neut D, Clark BM, Gottlieb T, Trebše R, Soriano A, Bahamonde A, Guío L, Rico A, Salles MJC, Pais MJG, Benito N, Riera M, Gómez L, Aboltins CA, Esteban J, Horcajada JP, O'Connell K, Ferrari M, Skaliczki G, Juan RS, Cobo J, Sánchez-Somolinos M, Ramos A, Giannitsioti E, Jover-Sáenz A, Baraia-Etxaburu JM, Barbero JM, Choong PFM, Asseray N, Ansart S, Moal GL, Zimmerli W, Ariza J. The Not-So-Good Prognosis of Streptococcal Periprosthetic Joint Infection Managed by Implant Retention: The Results of a Large Multicenter Study. Clin Infect Dis 2017; 64:1742-1752. [PMID: 28369296 DOI: 10.1093/cid/cix227] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/14/2017] [Indexed: 02/05/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Jaime Lora-Tamayo
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI)
| | - Éric Senneville
- Department of Infectious Diseases, Gustave Dron Hospital of Tourcoing, France
| | - Alba Ribera
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Infectious Diseases, Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | - Louis Bernard
- Department of Infectious Diseases, Hôpital Universitaire Bretonneau, Tours, France
- Centre de Référence pour les Infections Ostéo-Articulaires Complexes du Grand Ouest (CRIOGO)
| | - Michel Dupon
- Centre correspondant de prise en charge des Infections Ostéo-articulaires Complexes du Grand Sud-Ouest, CHU Bordeaux
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, and
| | - Ho Kwong Li
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | - Cédric Arvieux
- Centre de Référence pour les Infections Ostéo-Articulaires Complexes du Grand Ouest (CRIOGO)
- Department of Infectious Diseases, Rennes University Hospital, Rennes, France
| | - Martin Clauss
- Interdisciplinary Septic Surgical Unit, Kantonsspital Baselland, Liestal
| | - Ilker Uçkay
- Department of Infectious Diseases, Hôpitaux Universitaires Genève, Switzerland
| | - Dace Vigante
- Hospital of Traumatology and Orthopedics, Riga, Latvia
| | - Tristan Ferry
- Department of Infectious and Tropical Diseases, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, France
| | - José Antonio Iribarren
- Department of Infectious Diseases, Hospital Universitario Donostia, San Sebastián, Spain
| | - Trisha N Peel
- Department of Infectious Diseases, Saint Vincent's Public Hospital, Melbourne, Victoria, Australia
| | - Parham Sendi
- Department of Infectious Diseases, University Hospital of Bern, Switzerland
| | - Nina Gorišek Miksic
- Infectious Diseases Department, University Clinical Center, Maribor, Slovenia
| | - Dolors Rodríguez-Pardo
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona
| | - María Dolores Del Toro
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (Ibis), University of Seville, University Hospitals Virgen Macarena y Virgen del Rocío, and
| | - Marta Fernández-Sampedro
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ulrike Dapunt
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Germany
| | | | - Joshua S Davis
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Julián Palomino
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (Ibis), University of Seville, University Hospitals Virgen Macarena y Virgen del Rocío, and
| | - Danielle Neut
- Departments of Orthopedic Surgery and Biomedical Engineering, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Benjamin M Clark
- Department of Infectious Diseases, Fiona Stanley Hospital, Western Australia
| | - Thomas Gottlieb
- Department of Microbiology and Infectious Diseases, Concord Hospital, New South Wales, Australia
| | - Rihard Trebše
- Service for Bone Infections, Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
| | - Alex Soriano
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain
- ESCMID Study Group for Implant-Associated Infections (ESGIAI)
| | | | - Laura Guío
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Unit of Infectious Diseases, Hospital de Cruces, Barakaldo, and
| | - Alicia Rico
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - Mauro J C Salles
- Unit of Infectious Diseases, Department of Internal Medicine, Santa Casa de Misericórdia de São Paulo, Brazil
| | - M José G Pais
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Natividad Benito
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Unit of Infectious Diseases, Hospital Universitari de la Santa Creu I Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona
| | - Melchor Riera
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Internal Medicine, Hospital Son Espases, Palma de Mallorca, and
| | - Lucía Gómez
- Unit of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Spain
| | - Craig A Aboltins
- Department of Infectious Diseases, Northern Health, Victoria and University of Melbourne, Northern Clinical School, Australia
| | - Jaime Esteban
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, Madrid
| | | | - Karina O'Connell
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Matteo Ferrari
- Department of Orthopedics and Rehabilitation, Humanitas Research Hospital, Milano, Italy
| | - Gábor Skaliczki
- Department of Orthopedics, OrhopediClinic, Semmelweis University, Budapest, Hungary
| | - Rafael San Juan
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI)
| | - Javier Cobo
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS
| | - Mar Sánchez-Somolinos
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, and
| | - Antonio Ramos
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Efthymia Giannitsioti
- Department of Infectious Diseases, 4th Department of Internal Medicine, NKUA, ATTIKON University General Hospital, Athens, Greece
| | - Alfredo Jover-Sáenz
- Department of Infectious Diseases, Hospital Universitari Arnau de Vilanova, Lleida
| | | | - José María Barbero
- Department of Internal Medicine, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Peter F M Choong
- University of Melbourne, Departments of Surgery and Orthopaedic, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Nathalie Asseray
- Centre de Référence pour les Infections Ostéo-Articulaires Complexes du Grand Ouest (CRIOGO)
- Department of Infectious Diseases, Hôpital Universitaire Hôtel Dieu, Nantes
| | - Séverine Ansart
- Centre de Référence pour les Infections Ostéo-Articulaires Complexes du Grand Ouest (CRIOGO)
- Department of Infectious Diseases, Hôpital Universitaire La Cavale Blanche, Brest, and
| | - Gwenäel Le Moal
- Centre de Référence pour les Infections Ostéo-Articulaires Complexes du Grand Ouest (CRIOGO)
- Department of Infectious Diseases, Hôpital Universitaire La Miletrie, Poitiers, France
| | - Werner Zimmerli
- Interdisciplinary Septic Surgical Unit, Kantonsspital Baselland, Liestal
| | - Javier Ariza
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Infectious Diseases, Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain
| | | |
Collapse
|