Title :

The not-so-good prognosis of streptococcal periprosthetic joint infection managed by implant retention: the results of a large multicenter study

Author(s) :

Lora-Tamayo, Jaime [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
Ribera, Alba [Auteur]
Bernard, Louis [Auteur]
Dupon, Michel [Auteur]
Zeller, Valérie [Auteur]
Li, Ho Kwong [Auteur]
Arvieux, Cedric [Auteur]
Clauss, Martin [Auteur]
Uckay, Ilker [Auteur]
Vigante, Dace [Auteur]
Ferry, Tristan [Auteur]
Iribarren, Jose Antonio [Auteur]
Peel, Trisha N. [Auteur]
Sendi, Parham [Auteur]
Miksic, Nina Gorisek [Auteur]
Rodriguez-Pardo, Dolors [Auteur]
Dolores Del Toro, Maria [Auteur]
Fernandez-Sampedro, Marta [Auteur]
Dapunt, Ulrike [Auteur]
Huotari, Kaisa [Auteur]
Davis, Joshua S. [Auteur]
Palomino, Julian [Auteur]
Neut, Danielle [Auteur]
Clark, Benjamin M. [Auteur]
Gottlieb, Thomas [Auteur]
Trebse, Rihard [Auteur]
Soriano, Alex [Auteur]
Bahamonde, Alberto [Auteur]
Guio, Laura [Auteur]
Rico, Alicia [Auteur]
Salles, Mauro Jose [Auteur]
Pais, M Jose G. [Auteur]
Benito, Natividad [Auteur]
Riera, Melchor [Auteur]
Gomez, Lucia [Auteur]
Aboltins, Craig A. [Auteur]
Esteban, Jaime [Auteur]
Horcajada, Juan Pablo [Auteur]
O'connell, Karina [Auteur]
Ferrari, Matteo Carlo [Auteur]
Skaliczki, Gabor [Auteur]
San Juan, Rafael [Auteur]
Cobo, Javier [Auteur]
Sanchez-Somolinos, Mar [Auteur]
Ramos, Antonio [Auteur]
Giannitsioti, Efthymia [Auteur]
Jover-Saenz, Alfredo [Auteur]
Baraia-Etxaburu, Josu Mirena [Auteur]
Barbero, Jose Maria [Auteur]
Choong, Peter F M. [Auteur]
Asseray, Nathalie [Auteur]
Ansart, Severine [Auteur]
Le Moal, Gwenael [Auteur]
Zimmerli, Werner [Auteur]
Ariza, Javier [Auteur]

Journal title :

Clinical infectious diseases . an official publication of the Infectious Diseases Society of America

Abbreviated title :

Clin. Infect. Dis.

Volume number :

64

Pages :

1742-1752

Publication date :

2017-06-15

ISSN :

1058-4838

English keyword(s) :

DAIR
rifampin
biofilm
bone and joint infection

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

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 ...
Show more >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. 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. 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). 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.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
Université de Lille

Collections :

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

Submission date :

2019-12-09T18:16:36Z