Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention

Wouthuyzen-Bakker, Marjan; Sebillotte, Marine; Lomas, José Manuel; Taylor, Adrian; Benavent, Eva; Murillo, Óscar; Parvızı, Javad; Shohat, Noam; Reinoso, Javier Cobo; Sánchez, Rosa Escudero; Fernández-Sampedro, Marta; Senneville, Éric; Huotari, Kaisa; Barbero, J M; García-Cañete, Joaquin; Lora‐Tamayo, Jaime; Ferrari, Matteo Carlo; Važnaisienė, Danguolė; Yusuf, Erlangga; Aboltins, Craig; Trebše, Rihard; Salles, Mauro José Costa; Benito, Natividad; Vila, Andrea; Toro, María Dolores del; Kramer, Tobias Siegfried; Petersdorf, Sabine; Diaz-Brito, Vicens; Tufan, Zeliha Koçak; Sánchez, Marisa López; Arvieux, Cédric; Soriano, Álex

doi:10.1016/j.jinf.2018.07.014

Cited by 85 publications

(125 citation statements)

References 23 publications

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“…Patient characteristics have an impact on the outcome of treatment, as previously reported 13,15 and as confirmed in the present findings. Higher ASA score, age ≥ 80, and fracture as indication for operation were associated with non-eradication.…”

Section: Discussionsupporting

confidence: 91%

“…In addition to constituting early postoperative infections, these polymicrobial infections may also represent more fulminant infections that are diagnosed and managed earlier, explaining why there was a higher degree of eradication of S. aureus in this group. Early postoperative infections have a better outcome than the late acute and chronic PJIs 5,15 . Pain is more difficult to interpret, but is a symptom frequently associated with late acute and chronic PJIs.…”

Section: Discussionmentioning

confidence: 99%

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Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus

Wildeman

Tevell

Eriksson

et al. 2020

Sci Rep

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Staphylococcus aureus is a commensal colonizing the skin and mucous membranes. it can also act as a pathogen, and is the most common microorganism isolated from prosthetic joint infections (PJIs). The aim of this study was to explore the genomic relatedness between commensal and PJI S. aureus strains as well as microbial traits and host-related risk factors for treatment failure. Whole-genome sequencing (WGS) was performed on S. aureus isolates obtained from PJIs (n = 100) and control isolates from nares (n = 101). Corresponding clinical data for the PJI patients were extracted from medical records. No PJI-specific clusters were found in the WGS phylogeny, and the distribution of the various clonal complexes and prevalence of virulence genes among isolates from PJIs and nares was almost equal. Isolates from patients with treatment success and failure were genetically very similar, while the presence of an antibiotic-resistant phenotype and the use of non-biofilm-active antimicrobial treatment were both associated with failure.In conclusion, commensal and PJI isolates of S. aureus in arthroplasty patients were genetically indistinguishable, suggesting that commensal S. aureus clones are capable of causing PJIs. Furthermore, no association between genetic traits and outcome could be demonstrated, stressing the importance of patient-related factors in the treatment of S. aureus PJIs. Worldwide, millions of patients undergo arthroplasty surgery every year, with an expected increase in the coming years 1. Staphylococcus aureus is a major cause of both community-acquired and nosocomial infections, and is regularly reported to be the most common pathogen in prosthetic joint infections (PJIs) 2,3. Risk factors for developing PJIs are related to deficiencies in host defense due to age, obesity, previous surgery, smoking, and immune deficiencies (e.g. rheumatoid arthritis, diabetes mellitus), as well as exogenous factors such as timing and selection of antibiotic prophylaxis, extended operation time, and blood transfusions 4-8. Implant-sparing curative treatment of acute PJIs, whether occurring early in the postoperative period or later through hematogenous seeding, relies on a regimen of debridement, antibiotics, irrigation, and retention of the prosthesis (DAIR) 9. This is possible, provided that the infection has not persisted for more than approximately three weeks and that the isolate is susceptible to biofilm-active antibiotic treatment (i.e. rifampin for staphylococcal infections) 10. However, there are reports suggesting an even shorter time to intervention is needed for a successful treatment 11,12. The impact of risk factors on outcome of treatment has not been fully explored, but recent reports have proposed new risk scores to better guide the choice of treatment 13-15. S. aureus is a commensal of the human skin, nares, and mucous membranes, but also a human pathogen due to its invasive capacity. S. aureus infections occur among both otherwise-healthy individuals and those with co-morbidities, and nasal carriage...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus

Wildeman

Tevell

Eriksson

et al. 2020

Sci Rep

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“…However, in these cases, rifampin should not be administered. In several observational studies over the following years, the success rate in patients with PJI treated with a defined duration of rifampin combination therapy ranged between 55% and 100% (61,64,66,(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84). This wide range still triggers the discussion on the divergence of outcome results.…”

Section: Rifampin In Staphylococcal Pji In Humansmentioning

confidence: 99%

Role of Rifampin against Staphylococcal Biofilm Infections In Vitro , in Animal Models, and in Orthopedic-Device-Related Infections

Zimmerli

Sendi

2019

Antimicrob Agents Chemother

158

112

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Rifampin has been used as an agent in combination therapy in orthopedic device-related infections (ODRI) for almost three decades. The aim of this review is to provide data regarding the role of rifampin against biofilm infection in vitro, in animal models, and in clinical ODRI. Available data are gathered in order to present the rational use of rifampin combinations in patients with periprosthetic joint infection (PJI). The role of rifampin is well defined in patients with PJI and is indicated in those who fulfill the Infectious Diseases Society of America criteria for debridement and implant retention or one-stage exchange. It should be used with care because of the danger of rapid emergence of resistance. Potential drug interactions should be considered.

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“…6 The presented study is the first one in the field of silver-coated implants to demonstrate patients' age has as an independent risk factor of infection. This finding is not surprising as age-related higher complication rates have already been identified in the treatment of uncoated endoprosthetic infections, 28 the osteosynthesis of long bones, 29 and spinal fusion. 30 Although the patients' age itself is a non-modifiable factor, additional precautionary measures could be applied in elderly patients to reduce the implant infection risk, e.g., different perioperative antibiotic regimens, the use of local muscular flaps to ensure sufficient soft-tissue coverage or earlier aggressive drainage of haemathomas.…”

Section: Discussionmentioning

confidence: 63%

Infection risk analysis of 101 silver-coated endoprostheses

Mavčič¹,

Martinčič²,

Špiler³

et al. 2019

Mater. Tehnol.

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Our aim was to analyse the implant survival and infection rates of 101 consecutive silver-coated MUTARS® (= Modular Universal Tumour And Revision System) endoprostheses implanted at an independent orthopaedic tertiary hospital between April 1, 2011 and December 31, 2018 and to compare them with previous outcomes of the MUTARS® developmental hospitals. In addition, we tested the hypothesis that the infection-free survival rates of silver-coated implants depend on the patient's age, gender, pre-operative diagnoses and anatomical localization of the reconstruction. The cohort included 47 sarcoma resections, 29 revision arthroplasties, 20 metastatic resections, 3 benign bone tumours and 2 primary arthroplasties. Endoprosthesis was located in the distal femur (38 patients), proximal femur (29 patients), proximal humerus (12 patients), proximal tibia (10 patients), pelvis (6 patients), total femur (5 patients) and distal humerus (1 patient). The mean age at implantation was 49 (range 11-86) years and the mean follow-up 3.2 (range 0.1-7.7) years. Twenty-four patients required at least one subsequent revision operation and 15 endoprostheses had to be partially/totally removed. Patients' age was an independent risk factor for postoperative infection regardless of other confounding factors (hazard ratio 1.05 for each year; p = 0.02). With the overall postoperative infection rate 12 % (4 % reinfection + 8 % newly acquired) and cumulative partial/total implant removal rate 25 % after 5 years, complications were comparable to the previous series of the MUTARS® developmental hospitals with high variability between preoperative diagnoses and anatomical localizations. Silver-coated implants show a consistent trend of preventing infections in high-risk body regions and enabling more successful treatment should infection occur, but 10-15 years of clinical follow-up is required for further assessment.

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Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention

Abstract: LA PJIs have a high failure rate. Treatment strategies should be individualized according to patients' age, comorbidity, clinical presentation and microorganism causing the infection.

Cited by 85 publications

References 23 publications

Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus

Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus

Role of Rifampin against Staphylococcal Biofilm Infections In Vitro , in Animal Models, and in Orthopedic-Device-Related Infections

Infection risk analysis of 101 silver-coated endoprostheses

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