Titre :

Multidrug (mdr) and extensively drug resistant (xdr) gram negative prosthetic joint infections (pji): role of surgery and impact of colistin administration

Auteur(s) :

Papadopoulos, Antonios [Auteur]
Ribera, Alba [Auteur]
Mavrogenis, Andreas [Auteur]
Rodriguez-Pardo, Dolors [Auteur]
Bonnet, Eric [Auteur]
Hôpital Joseph Ducuing - Varsovie [Toulouse] [HJD]
Salles, Mauro Jose [Auteur]
Dolores Del Toro, Maria [Auteur]
Nguyen, Sophie [Auteur]
Centre Hospitalier Gustave Dron [Tourcoing]
Garcia, Antonio Blanco [Auteur]
Skaliczki, Gabor [Auteur]
Soriano, Alejandro [Auteur]
Benito, Natividad [Auteur]
Petersdorf, Sabine [Auteur]
Pasticci, Maria Bruna [Auteur]
Tattevin, Pierre [Auteur]
Université de Rennes [UR]
Tufan, Zeliha Kocak [Auteur]
Chan, Monica [Auteur]
Connell, Nuala O'''' [Auteur]
Pantazis, Nikos [Auteur]
Kyprianou, Aikaterini [Auteur]
Pigrau, Carl?s [Auteur]
Megaloikonomos, Panayiotis [Auteur]
Senneville, Eric [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
Cardenal, Javier Ariza [Auteur]
Papagelopoulos, Panayiotis [Auteur]
Giannitsioti, Efthymia [Auteur]

Titre de la revue :

International Journal of Antimicrobial Agents

Nom court de la revue :

Int. J. Antimicrob. Agents

Numéro :

53

Pagination :

294-301

Date de publication :

2019-03

ISSN :

1872-7913

Mot(s)-clé(s) en anglais :

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

Discipline(s) HAL :

Sciences du Vivant [q-bio]

Résumé en anglais : [en]

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 ...
Lire la suite >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.Lire moins >

Langue :

Anglais

Audience :

Internationale

Vulgarisation :

Non

Établissement(s) :

CHU Lille
Université de Lille

Collections :

• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694

Date de dépôt :

2019-12-09T18:20:43Z
2024-05-24T09:21:24Z