title: Characteristics of prosthetic joint infections due to Enterococcus sp. and predictors of failure: a multi-national study.
abstract: The objective of this study was to review the characteristics and outcome of prosthetic joint infections (PJI) due to Enterococcus sp. collected in 18 hospitals from six European countries. Patients with a PJI due to Enterococcus sp. diagnosed between January 1999 and July 2012 were retrospectively reviewed. Relevant information about demographics, comorbidity, clinical characteristics, microbiological data, surgical treatment and outcome was registered. Univariable and multivariable analyses were performed. A total of 203 patients met the inclusion criteria. The mean (SD) was 70.4 (13.6) years. In 59 patients the infection was diagnosed within the first 30 days (29.1%) from arthroplasty, in 44 (21.7%) between 31 and 90 days, in 54 (26.6%) between 91 days and 2 years and in 43 (21%) after 2 years. Enterococcus faecalis was isolated in 176 cases (89%). In 107 (54%) patients the infection was polymicrobial. Any comorbidity (OR 2.53, 95% CI 1.18-5.40, p 0.01), and fever (OR 2.65, 95% CI 1.23-5.69, p 0.01) were independently associated with failure. The only factor associated with remission was infections diagnosed later than 2 years (OR 0.25, 95% CI 0.09-0.71, p 0.009). In conclusion, prosthetic joint infections due to Enterococcus sp. were diagnosed within the first 2 years from arthroplasty in >70% of the patients, almost 50% had at least one comorbidity and infections were frequently polymicrobial (54%). The global failure rate was 44% and patients with comorbidities, fever, and diagnosed within the first 2 years from arthroplasty had a poor prognosis.
authors.affiliation: Bone and Joint Infection Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Tornero
authors.forename: E
authors.initials: E
authors.lastname: Senneville
authors.forename: G
authors.initials: G
authors.lastname: Euba
authors.forename: S
authors.initials: S
authors.lastname: Petersdorf
authors.forename: D
authors.initials: D
authors.lastname: Rodriguez-Pardo
authors.forename: B
authors.initials: B
authors.lastname: Lakatos
authors.forename: M C
authors.initials: MC
authors.lastname: Ferrari
authors.forename: M
authors.initials: M
authors.lastname: Pilares
authors.forename: A
authors.initials: A
authors.lastname: Bahamonde
authors.forename: R
authors.initials: R
authors.lastname: Trebse
authors.forename: N
authors.initials: N
authors.lastname: Benito
authors.forename: L
authors.initials: L
authors.lastname: Sorli
authors.forename: M D
authors.initials: MD
authors.lastname: del Toro
authors.forename: J M
authors.initials: JM
authors.lastname: Baraiaetxaburu
authors.forename: A
authors.initials: A
authors.lastname: Ramos
authors.forename: M
authors.initials: M
authors.lastname: Riera
authors.forename: A
authors.initials: A
authors.lastname: Jover-Sáenz
authors.forename: J
authors.initials: J
authors.lastname: Palomino
authors.forename: J
authors.initials: J
authors.lastname: Ariza
authors.forename: A
authors.initials: A
authors.lastname: Soriano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000453:epidemiology* / Q000382:microbiology; D060085:Coinfection / Q000453:epidemiology / Q000382:microbiology; D015897:Comorbidity; D016983:Enterococcus / Q000302:isolation & purification*; D005060:Europe / Q000453:epidemiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies
keywords: Debridement; Enterococcus faecalis; Enterococcus faecium; one-stage exchange; outcome; prosthetic joint infection; two-stage exchange