title: A large multicenter study of methicillin-susceptible and methicillin-resistant Staphylococcus aureus prosthetic joint infections managed with implant retention.
abstract: BACKGROUND
  Several series predicting the prognosis of staphylococcal prosthetic joint infection (PJI) managed with debridement, antibiotics, and implant retention (DAIR) have been published, but some of their conclusions are controversial. At present, little is known regarding the efficacy of the different antibiotics that are used or their ability to eliminate methicillin-resistant S. aureus (MRSA) infection.
  
  
  METHODS
  This was a retrospective, multicenter, observational study of cases of PJI by S. aureus that were managed with DAIR (2003-2010). Cases were classified as failures when infection persistence/relapse, death, need for salvage therapy, or prosthesis removal occurred. The parameters that predicted failure were analyzed with logistic and Cox regression.
  
  
  RESULTS
  Out of 345 episodes (41% men, 73 years), 81 episodes were caused by MRSA. Fifty-two were hematogenous, with poorer prognoses, and 88% were caused by methicillin-susceptible S. aureus (MSSA). Antibiotics were used for a median of 93 days, with similar use of rifampin-based combinations in MSSA- and MRSA-PJI. Failure occurred in 45% of episodes, often early after debridement. The median survival time was 1257 days. There were no overall prognostic differences between MSSA- and MRSA-PJI, but there was a higher incidence of MRSA-PJI treatment failure during the period of treatment (HR 2.34), while there was a higher incidence of MSSA-PJI treatment failure after therapy. Rifampin-based combinations exhibited an independent protective effect. Other independent predictors of outcome were polymicrobial, inflammatory, and bacteremic infections requiring more than 1 debridement, immunosuppressive therapy, and the exchange of removable components of the prosthesis.
  
  
  CONCLUSIONS
  This is the largest series of PJI by S. aureus managed with DAIR reported to date. The success rate was 55%. The use of rifampin may have contributed to homogenizing MSSA and MRSA prognoses, although the specific rifampin combinations may have had different efficacies.
authors.affiliation: Infectious Diseases, Hospital Universitario Bellvitge, IDIBELL, Universidad de Barcelona, Barcelona, Spain. jaime@lora-tamayo.es
authors.forename: Jaime
authors.initials: J
authors.lastname: Lora-Tamayo
authors.forename: Oscar
authors.initials: O
authors.lastname: Murillo
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Iribarren
authors.forename: Alex
authors.initials: A
authors.lastname: Soriano
authors.forename: Mar
authors.initials: M
authors.lastname: Sánchez-Somolinos
authors.forename: Josu Miren
authors.initials: JM
authors.lastname: Baraia-Etxaburu
authors.forename: Alicia
authors.initials: A
authors.lastname: Rico
authors.forename: Julián
authors.initials: J
authors.lastname: Palomino
authors.forename: Dolors
authors.initials: D
authors.lastname: Rodríguez-Pardo
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Horcajada
authors.forename: Natividad
authors.initials: N
authors.lastname: Benito
authors.forename: Alberto
authors.initials: A
authors.lastname: Bahamonde
authors.forename: Ana
authors.initials: A
authors.lastname: Granados
authors.forename: María Dolores
authors.initials: MD
authors.lastname: del Toro
authors.forename: Javier
authors.initials: J
authors.lastname: Cobo
authors.forename: Melchor
authors.initials: M
authors.lastname: Riera
authors.forename: Antonio
authors.initials: A
authors.lastname: Ramos
authors.forename: Alfredo
authors.initials: A
authors.lastname: Jover-Sáenz
authors.forename: Javier
authors.initials: J
authors.lastname: Ariza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D008875:Middle Aged; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013211:Staphylococcus aureus / Q000187:drug effects; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D012293:Rifampin