title: Pristinamycin in the treatment of MSSA bone and joint infection.
abstract: OBJECTIVE
  The aim of this study was to evaluate pristinamycin in the treatment of MSSA bone and joint infection (BJI).
  
  
  METHODS
  A retrospective, single-centre cohort study (2001-11) investigated outcome in adults receiving pristinamycin for MSSA BJI and pristinamycin-related adverse events (AEs).
  
  
  RESULTS
  One hundred and two MSSA BJIs were assessed in 98 patients [chronic infection, 33.3%; and orthopaedic device-related infection (ODI), 67.6%]. Surgery was performed in 77.5% of total cases, and in all but three ODIs, associated with antibiotic therapy of a median total duration of 29.2 weeks. Pristinamycin was prescribed as a part of the initial intensive treatment phase (29.4%) and/or included in final maintenance therapy (83.3%) at a dose of 47.6 (45.5-52.6) mg/kg/day for 9.3 (1.4-20.4) weeks. AEs occurred in 13.3% of patients, consisting of gastrointestinal disorder (76.9%) or allergic reaction (23.1%), leading to treatment interruption in 11 cases. AEs were related to daily dose (OR, 2.733 for each 10 additional mg/kg/day; P = 0.049). After a follow-up of 76.4 (29.6-146.9) weeks, the failure rate was 34.3%, associated with ODI (OR, 4.421; P = 0.006), particularly when the implant was retained (OR, 4.217; P = 0.007). In most patients, the pristinamycin companion drug was a fluoroquinolone (68.7%) or rifampicin (21.7%), without difference regarding outcome.
  
  
  CONCLUSIONS
  Pristinamycin is an effective, well-tolerated alternative therapeutic option in MSSA BJI, on condition that a daily dosage of 50 mg/kg is respected.
authors.affiliation: Department of Infectious Diseases, Hospices Civils de Lyon, 103 Grande-Rue de la Croix-Rousse, 69004 Lyon, France French Regional Reference Centre for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France International Centre for Research in Infectiology, INSERM U1111, Claude Bernard Lyon 1 University, Lyon, France florent.valour@chu-lyon.fr.
authors.forename: Florent
authors.initials: F
authors.lastname: Valour
authors.affiliation: Department of Infectious Diseases, Hospices Civils de Lyon, 103 Grande-Rue de la Croix-Rousse, 69004 Lyon, France French Regional Reference Centre for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France.
authors.forename: André
authors.initials: A
authors.lastname: Boibieux
authors.affiliation: Department of Infectious Diseases, Châlon-sur-Saône Hospital, Châlon-sur-Saône, France.
authors.forename: Judith
authors.initials: J
authors.lastname: Karsenty
authors.affiliation: Department of Infectious Diseases, Hospices Civils de Lyon, 103 Grande-Rue de la Croix-Rousse, 69004 Lyon, France French Regional Reference Centre for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France.
authors.forename: Marie-Paule
authors.initials: MP
authors.lastname: Vallat
authors.affiliation: Department of Infectious Diseases, Hospices Civils de Lyon, 103 Grande-Rue de la Croix-Rousse, 69004 Lyon, France French Regional Reference Centre for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Braun
authors.affiliation: Department of Infectious Diseases, Hospices Civils de Lyon, 103 Grande-Rue de la Croix-Rousse, 69004 Lyon, France French Regional Reference Centre for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Perpoint
authors.affiliation: Department of Infectious Diseases, Hospices Civils de Lyon, 103 Grande-Rue de la Croix-Rousse, 69004 Lyon, France French Regional Reference Centre for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Biron
authors.affiliation: French Regional Reference Centre for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France International Centre for Research in Infectiology, INSERM U1111, Claude Bernard Lyon 1 University, Lyon, France Laboratory of Bacteriology, French National Reference Centre for Staphylococci, Hospices Civils de Lyon, Lyon, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Laurent
authors.affiliation: French Regional Reference Centre for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France International Centre for Research in Infectiology, INSERM U1111, Claude Bernard Lyon 1 University, Lyon, France Orthopaedic Surgery Unit, Hospices Civils de Lyon, Lyon, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Lustig
authors.affiliation: Department of Infectious Diseases, Hospices Civils de Lyon, 103 Grande-Rue de la Croix-Rousse, 69004 Lyon, France French Regional Reference Centre for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France International Centre for Research in Infectiology, INSERM U1111, Claude Bernard Lyon 1 University, Lyon, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Chidiac
authors.affiliation: Department of Infectious Diseases, Hospices Civils de Lyon, 103 Grande-Rue de la Croix-Rousse, 69004 Lyon, France French Regional Reference Centre for Bone and Joint Infection, Hospices Civils de Lyon, Lyon, France International Centre for Research in Infectiology, INSERM U1111, Claude Bernard Lyon 1 University, Lyon, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Ferry
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D001850:Bone Diseases, Infectious / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008875:Middle Aged; D025762:Pristinamycin / Q000494:pharmacology / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D025762:Pristinamycin