Conservative treatment of staphylococcal prosthetic joint infections in elderly patients.
BACKGROUND
We report the outcome of debridement and prosthesis retention plus long-term levofloxacin/rifampicin treatment of prosthetic joint infections.


METHODS
Staphylococcal prosthesis joint infections were defined by positive culture of joint aspirate, intraoperative debridement specimens, or sinus tract discharge in the presence of clinical criteria. Patients received long-term oral levofloxacin 500 mg and rifampicin 600 mg once per day. Sixty patients (age 74.6+/-8.4 years) were included.


RESULTS
Coagulase-negative staphylococci were significantly more frequently isolated in the knee (78.6%; P=.00001). Of the Staphylococcus aureus isolates, 33.3% were methicillin-resistant. Time from arthroplasty to symptoms onset was higher (P=.03) in coagulase-negative staphylococci infections. Global failure was 35% (higher for the knee) and ranged from 16.6% to 69.2% (P=.0045) in patients with symptoms duration of less than 1 month to more than 6 months. A shorter duration of symptoms (P=.001) and time to diagnosis (P=.01) were found in cured patients versus patients showing failure. Among those with S. aureus infections, a higher failure rate was found with methicillin-resistance.


CONCLUSIONS
Efficacy was higher in patients with shorter duration of symptoms, earlier diagnosis, hip infections, and methicillin susceptibility.
Barberán
José
J
Infectious Diseases Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain.
Aguilar
Lorenzo
L
Carroquino
Guillermo
G
Giménez
María-José
MJ
Sánchez
Beatriz
B
Martínez
David
D
Prieto
José
J
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D016009:Chi-Square Distribution; D003646:Debridement; D004334:Drug Administration Schedule; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D007720:Knee Prosthesis / Q000009:adverse effects; D064704:Levofloxacin; D008297:Male; D016106:Methicillin Resistance; D015242:Ofloxacin / Q000627:therapeutic use; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D012293:Rifampin / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D013211:Staphylococcus aureus; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D015242:Ofloxacin; D012293:Rifampin