title: Acute haematogenous prosthetic joint infection: prospective evaluation of medical and surgical management.
abstract: The optimum treatment for prosthetic joint infections has not been clearly defined. We report our experience of the management of acute haematogenous prosthetic joint infection (AHPJI) in patients during a 3-year prospective study in nine Spanish hospitals. Fifty patients, of whom 30 (60%) were female, with a median age of 76 years, were diagnosed with AHPJI. The median infection-free period following joint replacement was 4.9 years. Symptoms were acute in all cases. A distant previous infection and/or bacteraemia were identified in 48%. The aetiology was as follows: Staphylococcus aureus, 19; Streptococcus spp., 14; Gram-negative bacilli, 12; anaerobes, two; and mixed infections, three. Thirty-four (68%) patients were treated with a conservative surgical approach (CSA) with implant retention, and 16 had prosthesis removal. At 2-year follow-up, 24 (48%) were cured, seven (14%) had relapsed, seven (14%) had died, five (10%) had persistent infection, five had re-infection, and two had an unknown evolution. Overall, the treatment failure rates were 57.8% in staphylococcal infections and 14.3% in streptococcal infections. There were no failures in patients with Gram-negative bacillary. By multivariate analysis, CSA was the only factor independently associated with treatment failure (OR 11.6; 95% CI 1.29-104.8). We were unable to identify any factors predicting treatment failure in CSA patients, although a Gram-negative bacillary aetiology was a protective factor. These data suggest that although conservative surgery was the only factor independently associated with treatment failure, it could be the first therapeutic choice for the management of Gram-negative bacillary and streptococcal AHPJI, and for some cases with acute S. aureus infections.
authors.affiliation: Infectious Diseases Division, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, Barcelona, Spain. dolorodriguez@vhebron.net
authors.forename: D
authors.initials: D
authors.lastname: Rodríguez
authors.forename: C
authors.initials: C
authors.lastname: Pigrau
authors.forename: G
authors.initials: G
authors.lastname: Euba
authors.forename: J
authors.initials: J
authors.lastname: Cobo
authors.forename: J
authors.initials: J
authors.lastname: García-Lechuz
authors.forename: J
authors.initials: J
authors.lastname: Palomino
authors.forename: M
authors.initials: M
authors.lastname: Riera
authors.forename: M D
authors.initials: MD
authors.lastname: Del Toro
authors.forename: A
authors.initials: A
authors.lastname: Granados
authors.forename: X
authors.initials: X
authors.lastname: Ariza
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D016470:Bacteremia / Q000628:therapy; D019090:Case Management; D004359:Drug Therapy, Combination; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D010346:Patient Care Management; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000601:surgery; D013290:Streptococcal Infections / Q000188:drug therapy / Q000601:surgery; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents