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The prognosis of streptococcal prosthetic bone and joint infections depends on surgical management—A multicenter retrospective study
- Source :
- International Journal of Infectious Diseases, International Journal of Infectious Diseases, Elsevier, 2019, 85, pp.175-181. ⟨10.1016/j.ijid.2019.06.012⟩, International Journal of Infectious Diseases, Vol 85, Iss, Pp 175-181 (2019)
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Background: The optimal treatment of streptococcal prosthetic joint infections (PJIs) is unclear. Methods: A cohort of streptococcal PJIs was reviewed retrospectively in seven reference centers for the management of complex bone and joint infections, covering the period January 1, 2010 to December 31, 2012. Results: Seventy patients with monomicrobial infections were included: 47 had infections of total hip arthroplasty and 23 had infections of total knee arthroplasty. The median age was 77 years (interquartile range (IQR) 69–83 years), the median Charlson comorbidity score was 4 (IQR 3–6), and 15.6% (n = 11) had diabetes. The most commonly identified streptococcal species were Streptococcus agalactiae and Streptococcus dysgalactiae (38.6% (n = 27) and 17.1% (n = 12), respectively). Debridement, antibiotics and implant retention (DAIR) was performed after a median time of 7 days (IQR 3–8 days), with polyethylene exchange (PE) in 21% of cases. After a minimum follow-up of 2 years, 27% of patients had relapsed, corresponding to 51.4% of DAIR treatment cases and 0% of one-stage (n = 15) or two-stage (n = 17) exchange strategy cases. Rifampicin or levofloxacin in combination therapy was not associated with a better outcome (adjusted p = 0.99). S. agalactiae species and DAIR treatment were associated with a higher risk of failure. On multivariate analysis, only DAIR treatment and S. agalactiae were independent factors of relapse. Compared to DAIR without PE, DAIR with PE was only associated with a trend towards a benefit (odds ratio 0.33, 95% confidence interval 0.06–1.96; adjusted p = 0.44). Conclusions: Streptococcal PJIs managed with DAIR have a poor prognosis and S. agalactiae seems to be an independent factor of treatment failure. Keywords: Streptococcal, Prosthetic bone and joint infection, Debridement, Antibiotic
- Subjects :
- Male
0301 basic medicine
[SDV]Life Sciences [q-bio]
Levofloxacin
medicine.disease_cause
0302 clinical medicine
Recurrence
Interquartile range
Treatment Failure
030212 general & internal medicine
Aged, 80 and over
General Medicine
Prognosis
Combined Modality Therapy
Anti-Bacterial Agents
3. Good health
Treatment Outcome
Infectious Diseases
Cohort
Drug Therapy, Combination
Female
Bone Diseases
Joint Diseases
Rifampin
Knee Prosthesis
medicine.drug
Microbiology (medical)
medicine.medical_specialty
Prosthesis-Related Infections
030106 microbiology
Streptococcus agalactiae
lcsh:Infectious and parasitic diseases
03 medical and health sciences
Streptococcal Infections
Internal medicine
medicine
Humans
lcsh:RC109-216
Aged
Retrospective Studies
business.industry
Streptococcus
Retrospective cohort study
Odds ratio
Confidence interval
Debridement
Hip Prosthesis
business
Rifampicin
Subjects
Details
- ISSN :
- 12019712 and 18783511
- Volume :
- 85
- Database :
- OpenAIRE
- Journal :
- International Journal of Infectious Diseases
- Accession number :
- edsair.doi.dedup.....f49bf3a2ff1523d1da89a120cce02f2c