title: Staphylococcal orthopaedic device-related infections in older patients.
abstract: BACKGROUND
  Staphylococci are the most common pathogens causing orthopaedic device-related infections (ODRI). The treatment of these infections often involves multiple surgical procedures combined with systemic antibiotic therapy to treat the infection and restore functionality. Older patients frequently present with a compromised health-status and/or low bone quality, and despite growing importance their outcomes are not well described to date. The primary aim of the current study is to describe outcomes in older patients with ODRIs and to determine if they demonstrate lower cure rates and greater risk for complications in contrast to younger patients.
  
  
  METHODS
  Patients treated with an ODRI of the lower extremity at our institution were included in this study. Demographic data, comorbidities and infecting organisms were recorded. Older adult patients were defined as those aged 60 and older. At two-year follow-up post-discharge, we recorded the clinical course, the Lower-Extremity-Functional-Score, the patient reported general health status (SF-12-questionnaire) and the status of infection. The antibiotic resistance pattern of the disease causing pathogens was analysed and compared between the two age groups.
  
  
  RESULTS
  In total, 163 patients (age: 19-94 years) with a staphylococcal ODRI were included. Sixty-four of these infections occurred in older patients, which showed a significantly higher mortality rate (9%). Within follow-up period recurrence of infection occurred significantly more frequently in younger patients (41%) than in older patients (17%). At two-years follow-up cure, which was defined as eradication of infection and terminated therapy, was achieved in 78% of younger and 75% of older patients. However, an ODRI resulted in older patients in a significantly worse functional outcome and impaired physical quality of live, as well as more frequently in an on-going infection, such as a persisting fistula (14% versus 3% in younger patients). Disease causing staphylococci, isolated from older patients showed more frequently a methicillin or multi-drug resistance than those associated with infections in younger patients.
  
  
  CONCLUSIONS
  ODRIs in older patients demonstrated higher morality rates rate, poor functional outcome and higher rates of persistent infections. A compromised health status and a poor bone quality may play a crucial role in this specific patient cohort.
authors.affiliation: Department of Trauma Surgery, Trauma Center Murnau, Germany; Department of Orthopaedic Surgery and Traumatology, University Hospital Basel, Switzerland; Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria. Electronic address: morgenstern.mario@gmail.com.
authors.forename: Mario
authors.initials: M
authors.lastname: Morgenstern
authors.affiliation: Department of Trauma Surgery, Trauma Center Murnau, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Erichsen
authors.affiliation: Department of Trauma Surgery, Trauma Center Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: von Rüden
authors.affiliation: Department of Trauma Surgery, University Hospitals Leuven, Belgium.
authors.forename: Willem J
authors.initials: WJ
authors.lastname: Metsemakers
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Kates
authors.affiliation: AO Research Institute, Davos, Switzerland.
authors.forename: T Fintan
authors.initials: TF
authors.lastname: Moriarty
authors.affiliation: Department of Trauma Surgery, Trauma Center Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria.
authors.forename: Sven
authors.initials: S
authors.lastname: Hungerer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D015897:Comorbidity; D024881:Drug Resistance, Bacterial; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D050723:Fractures, Bone / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D035002:Lower Extremity / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000382:microbiology*; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents
keywords: Implant infection; Older patient; Orthopaedic device-related infection; Orthopaedic surgery; Prosthetic joint infection; Staphylococci