Title :

Osteosynthesis-associated infection of the lower limbs by multidrug-resistant and extensively drug-resistant Gram-negative bacteria: a multicentre cohort study.

Author(s) :

Giannitsioti, Efthymia [Auteur]
National and Kapodistrian University of Athens [NKUA]
Salles, Mauro José [Auteur]
Universidade Paulista [São Paulo] [UNIP]
Mavrogenis, Andreas [Auteur]
National and Kapodistrian University of Athens [NKUA]
Rodriguez-Pardo, Dolors [Auteur]
Vall d'Hebron University Hospital [Barcelona]
Los-Arcos, Ibai [Auteur]
Vall d'Hebron University Hospital [Barcelona]
Ribera, Alba [Auteur]
Bellvitge University Hospital = Bellvitge Hospital Universitari
Ariza, Javier [Auteur]
Bellvitge University Hospital = Bellvitge Hospital Universitari
Del Toro, María Dolores [Auteur]
Hospital Universitario Virgen Macarena [Séville]
Nguyen, Sophie [Auteur]
Centre Hospitalier Gustave Dron [Tourcoing]
Bonnet, Eric [Auteur]
Clinique Pasteur [Toulouse]
Chan, Monica [Auteur]
Tan Tock Seng Hospital
Pasticci, Maria Bruna [Auteur]
Università degli Studi di Perugia = University of Perugia [UNIPG]
Petersdorf, Sabine [Auteur]
Benito, Natividad [Auteur]
Hospital de la Santa Creu i Sant Pau
O' Connell, Nuala [Auteur]
University of Limerick [UL]
Blanco García, Antonio Blanco [Auteur]
Skaliczki, Gábor [Auteur]
Semmelweis University [Budapest]
Tattevin, Pierre [Auteur]
Ankara Yildirim Beyazit University [Turkey]
Kocak Tufan, Zeliha [Auteur]
Ankara Yildirim Beyazit University [Turkey]
Pantazis, Nikolaos [Auteur]
National and Kapodistrian University of Athens [NKUA]
Megaloikonomos, Panayiotis D. [Auteur]
National and Kapodistrian University of Athens [NKUA]
Papagelopoulos, Panayiotis [Auteur]
National and Kapodistrian University of Athens [NKUA]
Soriano, Alejandro [Auteur]

Papadopoulos, Antonios [Auteur]
The Esgiai Collaborators Study, G. R. O. U. P. [Auteur]

Journal title :

Journal of Bone and Joint Infection

Abbreviated title :

J Bone Jt Infect

Volume number :

7

Pages :

279-288

Publication date :

2023-01-17

ISSN :

2206-3552

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Purpose: The purpose of this study was the clinical and therapeutic assessment of lower-limb osteosynthesis-associated infection (OAI) by multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria ...
Show more >Purpose: The purpose of this study was the clinical and therapeutic assessment of lower-limb osteosynthesis-associated infection (OAI) by multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria (GNB), which have been poorly studied to date. Methods: A prospective multicentre observational study was conducted on behalf of ESGIAI (the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Implant-Associated Infections). Factors associated with remission of the infection were evaluated by multivariate and Cox regression analysis for a 24-month follow-up period. Results: Patients ( n=57 ) had a history of trauma (87.7 %), tumour resection (7 %) and other bone lesions (5.3 %). Pathogens included Escherichia coli ( n=16 ), Pseudomonas aeruginosa ( n=14 ; XDR 50 %), Klebsiella spp. ( n=7 ), Enterobacter spp. ( n=9 ), Acinetobacter spp. ( n=5 ), Proteus mirabilis ( n=3 ), Serratia marcescens ( n=2 ) and Stenotrophomonas maltophilia ( n=1 ). The prevalence of ESBL (extended-spectrum β -lactamase), fluoroquinolone and carbapenem resistance were 71.9 %, 59.6 % and 17.5 % respectively. Most patients ( n=37 ; 64.9 %) were treated with a combination including carbapenems ( n=32 ) and colistin ( n=11 ) for a mean of 63.3 d. Implant retention with debridement occurred in early OAI (66.7 %), whereas the infected device was removed in late OAI (70.4 %) ( p=0.008 ). OAI remission was achieved in 29 cases (50.9 %). The type of surgery, antimicrobial resistance and duration of treatment did not significantly influence the outcome. Independent predictors of the failure to eradicate OAI were age >60 years (hazard ratio, HR, of 3.875; 95 % confidence interval, CI95 %, of 1.540-9.752; p=0.004 ) and multiple surgeries for OAI (HR of 2.822; CI95 % of 1.144-6.963; p=0.024 ). Conclusions: Only half of the MDR/XDR GNB OAI cases treated by antimicrobials and surgery had a successful outcome. Advanced age and multiple surgeries hampered the eradication of OAI. Optimal therapeutic options remain a challengeShow less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
CHU Lille

Collections :

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

Submission date :

2023-11-15T02:39:44Z
2024-03-28T14:54:51Z