Pubblicazioni

The Not-So-Good Prognosis of Streptococcal Periprosthetic Joint Infection Managed by Implant Retention: The Results of a Large Multicenter Study

Aprile 1, 2022

Jaime Lora-Tamayo ^{1 2} , Éric Senneville ³ , Alba Ribera ^{2 4 5} , Louis Bernard ^{6 7} , Michel Dupon ⁸ , Valérie Zeller ⁹ , Ho Kwong Li ⁵ , Cédric Arvieux ^{7 10} , Martin Clauss ¹¹ , Ilker Uçkay ¹² , Dace Vigante ¹³ , Tristan Ferry ¹⁴ , José Antonio Iribarren ¹⁵ , Trisha N Peel ¹⁶ , Parham Sendi ¹⁷ , Nina Gorišek Miksic ¹⁸ , Dolors Rodríguez-Pardo ^{2 19} , María Dolores Del Toro ^{2 20} , Marta Fernández-Sampedro ^{2 21} , Ulrike Dapunt ²² , Kaisa Huotari ²³ , Joshua S Davis ²⁴ , Julián Palomino ^{2 20} , Danielle Neut ²⁵ , Benjamin M Clark ²⁶ , Thomas Gottlieb ²⁷ , Rihard Trebše ²⁸ , Alex Soriano ^{2 29 30} , Alberto Bahamonde ³¹ , Laura Guío ^{2 32} , Alicia Rico ³³ , Mauro J C Salles ³⁴ , M José G Pais ³⁵ , Natividad Benito ^{2 36} , Melchor Riera ^{2 37} , Lucía Gómez ³⁸ , Craig A Aboltins ³⁹ , Jaime Esteban ⁴⁰ , Juan Pablo Horcajada ⁴¹ , Karina O’Connell ⁴² , Matteo Ferrari ⁴³ , Gábor Skaliczki ⁴⁴ , Rafael San Juan ^{1 2} , Javier Cobo ^{2 45} , Mar Sánchez-Somolinos ^{2 46} , Antonio Ramos ⁴⁷ , Efthymia Giannitsioti ⁴⁸ , Alfredo Jover-Sáenz ⁴⁹ , Josu Mirena Baraia-Etxaburu ⁵⁰ , José María Barbero ⁵¹ , Peter F M Choong ⁵² , Nathalie Asseray ^{7 53} , Séverine Ansart ^{7 54} , Gwenäel Le Moal ^{7 55} , Werner Zimmerli ¹¹ , Javier Ariza ^{2 4} , Group of Investigators for Streptococcal Prosthetic Joint Infection

Collaborators

Group of Investigators for Streptococcal Prosthetic Joint Infection: Fernando Chaves, José Alberto Moreno-Beamud, Rafael Navarro Arribas, Sophie Nguyen, Oscar Murillo, Xavier Cabo, Salvador Pedrero, Frédéric Dauchy, Hervé Dutronc, Bertille de Barbeyrac, Matthew Scarborough, Martin McNally, Bridget Atkins, Pierre Tattevin, Marie Ghéno, Enora Ouamara-Digue, Bernhard Kessler, Sébastien Lustig, Florent Valour, Christian Chdiac, Miguel Ángel Goenaga, Asier Mitxelena, Enrique Moreno, Maja Bombek Ihan, Zmago Krajnc, Carles Pigrau, Pablo S Corona Pérez-Cardona, Cecilia Peñas Espinar, Ana Isabel Suárez, Miguel Muniain Ezcurra, María Fariñas, Markku Vuorinen, Jarkko Leskinen, Tristan Yolland, Mark Lowenthal, Julia Praena, Salvador Fornell, María-José Gómez, Paul C Jutte, Anže Mihelič, Rene Mihalič, Guillem Bori, Laura Morata, Eduard Tornero, Carlos Fuster Foz, Susana García Villabrille, Marta Novoa, Emerson K Honda, Ricardo de Paula Leite Cury, Juan Corredoira, Pere Coll, Isabel Mur, Xavier Crusi, Antonio Ramírez, Francisco Montaner, Eva Cuchí, Antonio Blanco, Joaquín García-Cañete, Raúl Parrón, Luisa Sorlí, Lluis Puig, Nuria Prim, Botond Lakatos, Gyula Prinz, Gema Gresco, Patricia Ruiz-Garbajosa, Mercedes Marín Arriaza, Isabel Sánchez-Romero, Miguel Ángel García Viejo, Jesús Campo Loarte, Antonios Papadopoulos, María Fernanda Ramírez-Hidalgo, Laura Prats-Gispert, Ferran Pérez-Villar, Juan Romanyk, Guido Grappiolo, Mattia Loppini, Marco Scardino, Elaine Cheong, Genevieve McKew, Amarita Ronnachi

Affiliations

Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain.
Red Española de Investigación en Patología Infecciosa (REIPI).
Department of Infectious Diseases, Gustave Dron Hospital of Tourcoing, France.
Department of Infectious Diseases, Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain.
Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, United Kingdom.
Department of Infectious Diseases, Hôpital Universitaire Bretonneau, Tours, France.
Centre de Référence pour les Infections Ostéo-Articulaires Complexes du Grand Ouest (CRIOGO).
Centre correspondant de prise en charge des Infections Ostéo-articulaires Complexes du Grand Sud-Ouest, CHU Bordeaux.
Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, and.
Department of Infectious Diseases, Rennes University Hospital, Rennes, France.
Interdisciplinary Septic Surgical Unit, Kantonsspital Baselland, Liestal.
Department of Infectious Diseases, Hôpitaux Universitaires Genève, Switzerland.
Hospital of Traumatology and Orthopedics, Riga, Latvia.
Department of Infectious and Tropical Diseases, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, France.
Department of Infectious Diseases, Hospital Universitario Donostia, San Sebastián, Spain.
Department of Infectious Diseases, Saint Vincent’s Public Hospital, Melbourne, Victoria, Australia.
Department of Infectious Diseases, University Hospital of Bern, Switzerland.
Infectious Diseases Department, University Clinical Center, Maribor, Slovenia.
Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona.
Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (Ibis), University of Seville, University Hospitals Virgen Macarena y Virgen del Rocío, and.
Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Germany.
Helsinki University Hospital, Finland.
Department of Infectious Diseases, John Hunter Hospital, Newcastle, New South Wales, Australia.
Departments of Orthopedic Surgery and Biomedical Engineering, University of Groningen, University Medical Center Groningen, The Netherlands.
Department of Infectious Diseases, Fiona Stanley Hospital, Western Australia.
Department of Microbiology and Infectious Diseases, Concord Hospital, New South Wales, Australia.
Service for Bone Infections, Valdoltra Orthopaedic Hospital, Ankaran, Slovenia.
Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain.
ESCMID Study Group for Implant-Associated Infections (ESGIAI).
Department of Internal Medicine, Hospital de El Bierzo, Ponferrada.
Unit of Infectious Diseases, Hospital de Cruces, Barakaldo, and.
Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain.
Unit of Infectious Diseases, Department of Internal Medicine, Santa Casa de Misericórdia de São Paulo, Brazil.
Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain.
Unit of Infectious Diseases, Hospital Universitari de la Santa Creu I Sant Pau, Institut d’Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona.
Department of Internal Medicine, Hospital Son Espases, Palma de Mallorca, and.
Unit of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Spain.
Department of Infectious Diseases, Northern Health, Victoria and University of Melbourne, Northern Clinical School, Australia.
Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, Madrid.
Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain.
Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.
Department of Orthopedics and Rehabilitation, Humanitas Research Hospital, Milano, Italy.
Department of Orthopedics, OrhopediClinic, Semmelweis University, Budapest, Hungary.
Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS.
Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, and.
Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Madrid, Spain.
Department of Infectious Diseases, 4th Department of Internal Medicine, NKUA, ATTIKON University General Hospital, Athens, Greece.
Department of Infectious Diseases, Hospital Universitari Arnau de Vilanova, Lleida.
Department of Infectious Diseases, Hospital de Basurto, Bilbao, and.
Department of Internal Medicine, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain.
University of Melbourne, Departments of Surgery and Orthopaedic, St. Vincent’s Hospital, Melbourne, Victoria, Australia.
Department of Infectious Diseases, Hôpital Universitaire Hôtel Dieu, Nantes.
Department of Infectious Diseases, Hôpital Universitaire La Cavale Blanche, Brest, and.
Department of Infectious Diseases, Hôpital Universitaire La Miletrie, Poitiers, Franc

Abstract

Background: Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success.

Methods: A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy.

Results: Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34).

Conclusions: This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rifampin.

Keywords: DAIR; biofilm; bone and joint infection; rifampin.

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