title: Clinical spectrum and outcome of critically ill patients suffering from prosthetic joint infections.
abstract: OBJECTIVE
  To report the clinical characteristics and prognosis of prosthetic joint infections (PJIs) in Intensive care units (ICUs).
  
  
  METHODS
  Forty-one patients consecutively admitted to ICUs for PJIs between January 2004 and June 2011 were included in a retrospective case series.
  
  
  RESULTS
  A majority of patients (73 %) had severe underlying disease. Acute infection affected 26 patients (63 %). Blood cultures were positive in 16 patients (39 %). Staphylococcus species were the most commonly implicated causative organisms (n = 36, 88 %). The surgical strategy was two-stage replacement in 25 cases (61 %). The surgical procedure leading to ICU admission was mainly prosthesis removal with spacer implantation (n = 13, 32 %). Initial antibiotherapy was a broad-spectrum beta-lactam antibiotic combined with a glycopeptide, linezolid, or daptomycin in 26 cases (63 %). Mortality in the ICU was 20 %. In nonsurvivors, diabetes, acute infection, and American Society of Anesthesiologists (ASA) score >3 were more frequent. The distribution of surgical strategies and procedures was not statistically different in survivors and nonsurvivors. The proportion of patients treated with antibiotherapy adjusted according to previous microbiological findings was higher in nonsurvivors (50 vs. 12 %, p = 0.02).
  
  
  CONCLUSIONS
  In our case series of critically ill patients suffering from PJI, factors associated with a poor outcome were diabetes mellitus, ASA score >3, and acute infection. Surgical strategies and surgical procedures had no significant impact on the ICU mortality. Adjustment of initial antibiotherapy according to previous microbiological findings should be made with caution.
authors.affiliation: Service de Réanimation et Maladies Infectieuses, Hôpital Dron, 135 avenue du Président Coty, 59200, Tourcoing, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Maaloum
authors.forename: A
authors.initials: A
authors.lastname: Meybeck
authors.forename: D
authors.initials: D
authors.lastname: Olive
authors.forename: N
authors.initials: N
authors.lastname: Boussekey
authors.forename: P-Y
authors.initials: PY
authors.lastname: Delannoy
authors.forename: A
authors.initials: A
authors.lastname: Chiche
authors.forename: H
authors.initials: H
authors.lastname: Georges
authors.forename: E
authors.initials: E
authors.lastname: Beltrand
authors.forename: E
authors.initials: E
authors.lastname: Senneville
authors.forename: T
authors.initials: T
authors.lastname: d'Escrivan
authors.forename: O
authors.initials: O
authors.lastname: Leroy
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016638:Critical Illness / Q000401:mortality*; D020878:Device Removal; D003920:Diabetes Mellitus / Q000382:microbiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007592:Joint Diseases / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D019736:Prostheses and Implants; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013210:Staphylococcus / Q000302:isolation & purification; D013582:Synovial Fluid / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents