Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study

We aim to evaluate the epidemiology and outcome of gram-negative prosthetic joint infection (GN-PJI) treated with debridement, antibiotics and implant retention (DAIR), identify factors predictive of failure, and determine the impact of ciprofloxacin use on prognosis. We performed a retrospective, m...

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Published in:Clinical microbiology and infection 2014-11, Vol.20 (11), p.O911-O919
Main Authors: Rodríguez-Pardo, D., Pigrau, C., Lora-Tamayo, J., Soriano, A., del Toro, M.D., Cobo, J., Palomino, J., Euba, G., Riera, M., Sánchez-Somolinos, M., Benito, N., Fernández-Sampedro, M., Sorli, L., Guio, L., Iribarren, J.A., Baraia-Etxaburu, J.M., Ramos, A., Bahamonde, A., Flores-Sánchez, X., Corona, P.S., Ariza, J.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Arthritis - therapy
Ciprofloxacin
Ciprofloxacin - therapeutic use
Debridement
Enterobacteriaceae
Female
gram-negative bacteria
Gram-Negative Bacterial Infections - therapy
Humans
Male
prognosis
Prosthesis Retention
Prosthesis-Related Infections - therapy
prosthetic joint infection
Pseudomonas
Retrospective Studies
Spain
Treatment Outcome
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Summary:We aim to evaluate the epidemiology and outcome of gram-negative prosthetic joint infection (GN-PJI) treated with debridement, antibiotics and implant retention (DAIR), identify factors predictive of failure, and determine the impact of ciprofloxacin use on prognosis. We performed a retrospective, multicentre, observational study of GN-PJI diagnosed from 2003 through to 2010 in 16 Spanish hospitals. We define failure as persistence or reappearance of the inflammatory joint signs during follow-up, leading to unplanned surgery or repeat debridement >30 days from the index surgery related death, or suppressive antimicrobial therapy. Parameters predicting failure were analysed with a Cox regression model. A total of 242 patients (33% men; median age 76 years, interquartile range (IQR) 68–81) with 242 episodes of GN-PJI were studied. The implants included 150 (62%) hip, 85 (35%) knee, five (2%) shoulder and two (1%) elbow prostheses. There were 189 (78%) acute infections. Causative microorganisms were Enterobacteriaceae in 78%, Pseudomonas spp. in 20%, and other gram-negative bacilli in 2%. Overall, 19% of isolates were ciprofloxacin resistant. DAIR was used in 174 (72%) cases, with an overall success rate of 68%, which increased to 79% after a median of 25 months' follow-up in ciprofloxacin-susceptible GN-PJIs treated with ciprofloxacin. Ciprofloxacin treatment exhibited an independent protective effect (adjusted hazard ratio (aHR) 0.23; 95% CI, 0.13–0.40; p
ISSN:1198-743X
1469-0691
DOI:10.1111/1469-0691.12649