Gram-negative prosthetic joint infections managed according to a multidisciplinary standardized approach: risk factors for failure and outcome with and without fluoroquinolones.
To describe the outcome and risk factors for treatment failure of 76 Gram-negative bacilli (GNB) prosthetic joint infections (PJIs) managed with a curative intent according to a standardized protocol derived from published guidelines.



We analysed data from all the cases of GNB-PJI treated surgically over an 8 year period. Treatment failure was defined as persistence or recurrence of PJI signs during follow-up, resulting in additional surgery and/or antibiotic administration or death.



Treatment failure within the follow-up period (median = 2.6 years) was observed in 16 of 76 (21.1%) patients. The failure rate was similar whether the patients were treated with fluoroquinolones in the whole cohort (22.4% versus 16.7%, P = 0.75) and after stratification according to the surgical procedure. The low failure rate observed in patients not receiving fluoroquinolones might be explained by the standardized attitude of maintaining intravenous β-lactams throughout treatment duration (median = 90 days). In multivariate analysis, C-reactive protein level ≥175 mg/L was significantly associated with treatment failure (adjusted HR = 7.75, 95% CI = 2.66-22.59, P < 0.0001).



Management according to standardized procedures may improve the prognosis of GNB-PJI. Intravenous β-lactams, continued for 3 months, should be considered an effective alternative to fluoroquinolones.
Service des Maladies Infectieuses, Centre Hospitalier Universitaire, 1 place Alexis Ricordeau, 44093 Nantes cedex 1, France Département de Médecine Interne - Infectiologie, Nouvelles Cliniques Nantaises, 3 rue Eric Tabarly, 44277 Nantes cedex 2, France ogrossi@ncn.fr.
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Grossi
Service des Maladies Infectieuses, Centre Hospitalier Universitaire, 1 place Alexis Ricordeau, 44093 Nantes cedex 1, France.
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Asseray
Unité de Gestion du Risque Infectieux, Centre Hospitalier Universitaire, 1 place Alexis Ricordeau, 44093 Nantes cedex 1, France.
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Bourigault
Service de Bactériologie, Centre Hospitalier Universitaire, 1 place Alexis Ricordeau, 44093 Nantes cedex 1, France.
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Corvec
Service des Maladies Infectieuses, Centre Hospitalier Universitaire, 1 place Alexis Ricordeau, 44093 Nantes cedex 1, France.
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Valette
Service de Pharmacie Clinique, Centre Hospitalier Universitaire, 1 place Alexis Ricordeau, 44093 Nantes cedex 1, France.
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Navas
Clinique Chirurgicale Orthopédique et Traumatologique, Centre Hospitalier Universitaire, 1 place Alexis Ricordeau, 44093 Nantes cedex 1, France.
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Happi-Djeukou
Clinique Chirurgicale Orthopédique et Traumatologique, Centre Hospitalier Universitaire, 1 place Alexis Ricordeau, 44093 Nantes cedex 1, France.
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Touchais
Service de Bactériologie, Centre Hospitalier Universitaire, 1 place Alexis Ricordeau, 44093 Nantes cedex 1, France.
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Bémer
Service des Maladies Infectieuses, Centre Hospitalier Universitaire, 1 place Alexis Ricordeau, 44093 Nantes cedex 1, France.
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Boutoille
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy*; D016459:Prosthesis-Related Infections / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones