title: Outcome and predictors of treatment failure in early post-surgical prosthetic joint infections due to Staphylococcus aureus treated with debridement.
abstract: Experience with debridement and prosthesis retention in early prosthetic joint infections (PJI) due to Staphylococcus aureus is scarce. The present study aimed to evaluate the outcome and predictors of failure. Patients prospectively registered with an early PJI due to S. aureus and 2 years of follow-up were reviewed. Demographics, co-morbidity, type of implant, clinical manifestations, surgical treatment, antimicrobial therapy and outcome were recorded. Remission was defined when the patient had no symptoms of infection, the prosthesis was retained and C-reactive protein (CRP) was ≤ 1 mg/dL. Univariate and multivariate analysis were performed. Fifty-three patients with a mean ± SD age of 70 ± 10.8 years were reviewed. Thirty-five infections were on knee prosthesis and 18 were on hip prosthesis. The mean ± SD duration of intravenous and oral antibiotics was 10.6 ± 6.7 and 88 ± 45.9 days, respectively. After 2 years of follow-up, 40 (75.5%) patients were in remission. Variables independently associated with failure were the need for a second debridement (OR 20.4, 95% CI 2.3-166.6, p 0.006) and a CRP > 22 mg/dL (OR 9.8, 95% CI 1.5-62.5, p 0.01). The onset of the infection within the 25 days after joint arthroplasty was at the limit of significance (OR 8.3, 95% CI 0.8-85.6, p 0.07). Debridement followed by a short period of antibiotics is a reasonable treatment option in early PJI due to S. aureus. Predictors of failure were the need for a second debridement to control the infection a CRP > 22 mg/dL and the infection onset within the first 25 days after joint arthroplasty.
authors.affiliation: Department of Orthopedics of Hospital Clínic of Barcelona, Spain. drvilchez@live.com.mx
authors.forename: F
authors.initials: F
authors.lastname: Vilchez
authors.forename: J C
authors.initials: JC
authors.lastname: Martínez-Pastor
authors.forename: S
authors.initials: S
authors.lastname: García-Ramiro
authors.forename: G
authors.initials: G
authors.lastname: Bori
authors.forename: F
authors.initials: F
authors.lastname: Maculé
authors.forename: J
authors.initials: J
authors.lastname: Sierra
authors.forename: L
authors.initials: L
authors.lastname: Font
authors.forename: J
authors.initials: J
authors.lastname: Mensa
authors.forename: A
authors.initials: A
authors.lastname: Soriano
mesh_terms: D000368:Aged; D003646:Debridement; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects / Q000382:microbiology; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D007720:Knee Prosthesis / Q000009:adverse effects / Q000382:microbiology; D008297:Male; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000628:therapy*; D012008:Recurrence; D013203:Staphylococcal Infections / Q000209:etiology / Q000628:therapy*; D017211:Treatment Failure