Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study.
We aim to evaluate the epidemiology and outcome of gram-negative prosthetic joint infection (GN-PJI) treated with debridement, antibiotics and implant retention (DAIR), identify factors predictive of failure, and determine the impact of ciprofloxacin use on prognosis. We performed a retrospective, multicentre, observational study of GN-PJI diagnosed from 2003 through to 2010 in 16 Spanish hospitals. We define failure as persistence or reappearance of the inflammatory joint signs during follow-up, leading to unplanned surgery or repeat debridement>30 days from the index surgery related death, or suppressive antimicrobial therapy. Parameters predicting failure were analysed with a Cox regression model. A total of 242 patients (33% men; median age 76 years, interquartile range (IQR) 68-81) with 242 episodes of GN-PJI were studied. The implants included 150 (62%) hip, 85 (35%) knee, five (2%) shoulder and two (1%) elbow prostheses. There were 189 (78%) acute infections. Causative microorganisms were Enterobacteriaceae in 78%, Pseudomonas spp. in 20%, and other gram-negative bacilli in 2%. Overall, 19% of isolates were ciprofloxacin resistant. DAIR was used in 174 (72%) cases, with an overall success rate of 68%, which increased to 79% after a median of 25 months' follow-up in ciprofloxacin-susceptible GN-PJIs treated with ciprofloxacin. Ciprofloxacin treatment exhibited an independent protective effect (adjusted hazard ratio (aHR) 0.23; 95% CI, 0.13-0.40; p<0.001), whereas chronic renal impairment predicted failure (aHR, 2.56; 95% CI, 1.14-5.77; p 0.0232). Our results confirm a 79% success rate in ciprofloxacin-susceptible GN-PJI treated with debridement, ciprofloxacin and implant retention. New therapeutic strategies are needed for ciprofloxacin-resistant PJI.
Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
D
D
Rodríguez-Pardo
C
C
Pigrau
J
J
Lora-Tamayo
A
A
Soriano
M D
MD
del Toro
J
J
Cobo
J
J
Palomino
G
G
Euba
M
M
Riera
M
M
Sánchez-Somolinos
N
N
Benito
M
M
Fernández-Sampedro
L
L
Sorli
L
L
Guio
J A
JA
Iribarren
J M
JM
Baraia-Etxaburu
A
A
Ramos
A
A
Bahamonde
X
X
Flores-Sánchez
P S
PS
Corona
J
J
Ariza
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001168:Arthritis / Q000628:therapy*; D002939:Ciprofloxacin / Q000627:therapeutic use; D003646:Debridement; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000628:therapy*; D006801:Humans; D008297:Male; D060489:Prosthesis Retention; D016459:Prosthesis-Related Infections / Q000628:therapy*; D012189:Retrospective Studies; D013030:Spain; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin
Ciprofloxacin; debridement; gram-negative bacteria; prognosis; prosthetic joint infection