title: Higher risk of failure of methicillin-resistant Staphylococcus aureus prosthetic joint infections.
abstract: We determined the effect of methicillin resistance on the outcome of patients with Staphylococcus aureus prosthetic joint infections. From January 1995 to December 2004, 33% of 137 episodes of prosthetic joint infections were the result of S. aureus (in monomicrobial or polymicrobial cultures). Thirty-three (24%) episodes among 31 patients were the result of methicillin-susceptible S. aureus and 12 (9%) episodes among 12 patients were the result of methicillin-resistant S. aureus. Overall treatment failure rate was 38%. Patients with methicillin-susceptible S. aureus or methicillin-resistant S. aureus prosthetic joint infections did not differ in age, gender, comorbidities, joint age, prior surgical procedures performed on the affected joint, number of postsurgical medical complications, or duration of intravenous antimicrobial therapy. Patients with methicillin-resistant S. aureus prosthetic joint infection had longer hospital durations (median, 15 versus 10 days). Methicillin-resistant S. aureus in periprosthetic tissue culture resulted in a higher risk of treatment failure (hazard ratio, 9.2; 95% confidence interval, 2.40-35.46) than methicillin-susceptible S. aureus when controlling for joint location (total knee arthroplasty versus total hip arthroplasty [hazard ratio, 5.8; 95% confidence interval, 1.52-22.19]) and removal of hardware (hazard ratio, 0.24; 95% confidence interval, 0.077-0.75). Efforts should be made to prevent methicillin-resistant S. aureus infections of joint arthroplasties and develop new treatment modalities.
authors.affiliation: Medical University of South Carolina, Charleston, SC 29425, USA. salgado@musc.edu
authors.forename: Cassandra D
authors.initials: CD
authors.lastname: Salgado
authors.forename: Sangita
authors.initials: S
authors.lastname: Dash
authors.forename: J Robert
authors.initials: JR
authors.lastname: Cantey
authors.forename: Camelia E
authors.initials: CE
authors.lastname: Marculescu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D015999:Multivariate Analysis; D016459:Prosthesis-Related Infections / Q000382:microbiology*; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000187:drug effects*; D017211:Treatment Failure