title: Oral Therapy, Microbiological Findings, and Comorbidity Influence the Outcome of Prosthetic Joint Infections Undergoing 2-Stage Exchange.
abstract: The aim of the present study was to investigate potential predictive factors of an unfavorable outcome in patients with prosthetic joint infection (PJI) undergoing 2-stage exchange.
  
  
  
  Patients with PJI undergoing 2-stage exchange and observed over a 5-year period (2009-2013) were included. Cure was defined by the disappearance of infection after a 96-week follow-up period. Statistical analysis was performed using the Mann-Whitney U test, the Fisher exact test, and the multivariate analysis.
  
  
  
  One-hundred twenty-two patients with PJI were included (median age, 69 years [range, 36-80 years]; 48% males, 47 hip PJI, and 75 knee PJI). Known comorbidities related to an increased risk of infection were reported in 43 patients (35%). Microbiological definition was obtained in 101 (83%) patients, and Staphylococcus aureus was isolated in 44 (36%) patients. Coagulase-negative staphylococci were isolated in 41 (34%) patients. A favorable outcome was obtained in 102 of 122 patients (84%). After univariate analysis, bacterial growth from operative specimens (P = .007), growth of Gram-positive bacteria (P < .001), use of oral therapy (P = .01), and absence of known comorbidities (P = .02) were associated with favorable outcome. Administration of rifampin (P = .99) and results of blood analysis were not predictive of outcome. After multivariate analysis was applied, infection sustained by Gram-positive bacteria, administration of oral antibiotics, and absence of known comorbidities frequently resulted in favorable outcome.
  
  
  
  A favorable outcome in patients with PJI undergoing 2-stage procedure was associated with an infection sustained by Gram-positive bacteria, absence of known comorbidities, and administration of oral therapy. Therefore, failure rate can be reduced with appropriate treatment choices.
authors.affiliation: Department of Infectious Diseases, D. Cotugno Hospital, AORN Dei Colli, Naples, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Ascione
authors.affiliation: Department of Infectious Diseases, D. Cotugno Hospital, AORN Dei Colli, Naples, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Pagliano
authors.affiliation: Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Balato
authors.affiliation: Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Mariconda
authors.affiliation: Department of Orthopaedic Surgery, CTO Hospital, AORN Dei Colli, Naples, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Rotondo
authors.affiliation: Department of Infectious Diseases, University of Salerno, Salerno, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Esposito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects / Q000382:microbiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007592:Joint Diseases; D007719:Knee Joint; D007720:Knee Prosthesis / Q000009:adverse effects / Q000382:microbiology; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D019736:Prostheses and Implants; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000601:surgery; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000188:drug therapy; D013211:Staphylococcus aureus; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D012293:Rifampin
keywords: 2-stage exchange; diagnosis; infection; prosthetic joint infections; treatment