title: Outcome of patients with streptococcal prosthetic joint infections with special reference to rifampicin combinations.
abstract: Outcome of patients with streptococcal prosthetic joint infections (PJIs) is not well known.
  
  
  
  We performed a retrospective multicenter cohort study that involved patients with total hip/knee prosthetic joint (THP/TKP) infections due to Streptococcus spp. from 2001 through 2009.
  
  
  
  Ninety-five streptococcal PJI episodes (50 THP and 45 TKP) in 87 patients of mean age 69.1 ± 13.7 years met the inclusion criteria. In all, 55 out of 95 cases (57.9 %) were treated with debridement and retention of the infected implants with antibiotic therapy (DAIR). Rifampicin-combinations, including with levofloxacin, were used in 52 (54.7 %) and 28 (29.5 %) cases, respectively. After a mean follow-up period of 895 days (IQR: 395-1649), the remission rate was 70.5 % (67/95). Patients with PJIs due to S. agalactiae failed in the same proportion as in the other patients (10/37 (27.1 %) versus 19/58 (32.7 %); p = .55). In the univariate analysis, antibiotic monotherapy, DAIR, antibiotic treatments other than rifampicin-combinations, and TKP were all associated with a worse outcome. The only independent variable significantly associated with the patients' outcomes was the location of the prosthesis (i.e., hip versus knee) (OR = 0.19; 95 % CI 0.04-0.93; p value 0.04).
  
  
  
  The prognosis of streptococcal PJIs may not be as good as previously reported, especially for patients with an infected total knee arthroplasty. Rifampicin combinations, especially with levofloxacin, appear to be suitable antibiotic regimens for these patients.
authors.affiliation: Infectious Diseases Department, University Hospital of Rouen, Rouen, France.
authors.forename: E
authors.initials: E
authors.lastname: Fiaux
authors.affiliation: Laboratory of Microbiology, University Hospital of Lille, Lille, France.
authors.forename: M
authors.initials: M
authors.lastname: Titecat
authors.affiliation: Infectious Diseases Department, Gustave Dron Hospital of Tourcoing, 135 rue du Président Coty, 59200, Tourcoing, France.
authors.forename: O
authors.initials: O
authors.lastname: Robineau
authors.affiliation: Unit of Infectious Diseases Hospital 12 de Octubre of Madrid, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Lora-Tamayo
authors.affiliation: Infectious Diseases Department, University Hospital of Amiens, Amiens, France.
authors.forename: Y
authors.initials: Y
authors.lastname: El Samad
authors.affiliation: Infectious Diseases Department, University Hospital of Rouen, Rouen, France.
authors.forename: M
authors.initials: M
authors.lastname: Etienne
authors.affiliation: Laboratory of Microbiology, University Hospital of Rouen, Rouen, France.
authors.forename: N
authors.initials: N
authors.lastname: Frebourg
authors.affiliation: Laboratory of Microbiology, Gustave Dron Hospital of Tourcoing, Tourcoing, France.
authors.forename: N
authors.initials: N
authors.lastname: Blondiaux
authors.affiliation: Orthopaedic Surgery Unit, University Hospital of Amiens, Amiens, France.
authors.forename: B
authors.initials: B
authors.lastname: Brunschweiler
authors.affiliation: Orthopaedic Surgery Unit, University Hospital of Rouen, Rouen, France.
authors.forename: F
authors.initials: F
authors.lastname: Dujardin
authors.affiliation: Orthopaedic Surgery Unit, Gustave Dron Hospital of Tourcoing, Tourcoing, France.
authors.forename: E
authors.initials: E
authors.lastname: Beltrand
authors.affiliation: Laboratory of Microbiology, University Hospital of Lille, Lille, France.
authors.forename: C
authors.initials: C
authors.lastname: Loiez
authors.affiliation: Laboratory of Microbiology, University Hospital of Caen, Caen, France.
authors.forename: V
authors.initials: V
authors.lastname: Cattoir
authors.affiliation: Orthopaedic Surgery Unit, University Hospital of Amiens, Amiens, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Canarelli
authors.affiliation: Orthopaedic Surgery Unit, University Hospital of Caen, Caen, France.
authors.forename: C
authors.initials: C
authors.lastname: Hulet
authors.affiliation: Infectious Diseases Department, Gustave Dron Hospital of Tourcoing, 135 rue du Président Coty, 59200, Tourcoing, France.
authors.forename: M
authors.initials: M
authors.lastname: Valette
authors.affiliation: Infectious Diseases Department, Gustave Dron Hospital of Tourcoing, 135 rue du Président Coty, 59200, Tourcoing, France.
authors.forename: S
authors.initials: S
authors.lastname: Nguyen
authors.affiliation: Infectious Diseases Department, University Hospital of Rouen, Rouen, France.
authors.forename: F
authors.initials: F
authors.lastname: Caron
authors.affiliation: Orthopaedic Surgery Unit, University Hospital of Lille, Lille, France.
authors.forename: H
authors.initials: H
authors.lastname: Migaud
authors.affiliation: Infectious Diseases Department, Gustave Dron Hospital of Tourcoing, 135 rue du Président Coty, 59200, Tourcoing, France. esenneville@ch-tourcoing.fr.|French Reference Center for Osteo-Articular Infections (CRIOAC Lille-Tourcoing), Faculty Hospital of Lille, Lille, France. esenneville@ch-tourcoing.fr.
authors.forename: E
authors.initials: E
authors.lastname: Senneville
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001168:Arthritis / Q000188:drug therapy; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects / Q000382:microbiology; D006801:Humans; D007719:Knee Joint / Q000382:microbiology / Q000601:surgery; D007720:Knee Prosthesis / Q000009:adverse effects / Q000382:microbiology; D064704:Levofloxacin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D012293:Rifampin / Q000008:administration & dosage*; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D012293:Rifampin
keywords: Outcome; Prosthetic joint infection; Rifampicin; Risk factors; Streptococcus spp