Staphylococcus lugdunensis prosthetic joint infection: A multicentric cohort study

•S. lugdunensis PJI are difficult-to-treat, with a failure rate of 20%.•An appropriate surgical strategy is crucial for treatment outcome.•Rifampin-based regimens significantly improve outcome.•DAIR should be restricted to patients with no other risk factor for treatment failure.•Suppressive antimicrobial therapy is an acceptable alternative for high-risk patients. To describe Staphylococcus lugdunensis prosthetic joint infection (PJI) management and outcome. Adults with proven S. lugdunensis PJI were included in a multicentric retrospective cohort. Determinants for failure were assessed by logistic regression and treatment failure-free survival curve analysis (Kaplan-Meier). One hundred and eleven patients were included (median age 72.4 [IQR, 62.7–79.4] years), with a knee (n = 71, 64.0%) or hip (n = 39, 35.1%) PJI considered as chronic in 77 (69.4%) cases. Surgical management consisted in debridement, antibiotic with implant retention (DAIR; n = 60, 54.1%), two-stage (n = 28, 25.2%) or one-stage (n = 15, 13.5%) exchange. Total duration of antimicrobial therapy was 13.1 (IQR, 11.8–16.9) weeks. After a median follow-up of 99.9 (IQR, 53.9–178.1) weeks, 22 (19.8%) S. lugdunensis-related treatment failures were observed. Independent determinants for outcome were diabetes (OR, 3.741; p = 0.036), sinus tract (OR, 3.846; p = 0.032), DAIR (OR, 3.749; p = 0.039) and rifampin-based regimen (OR, 0.319; p = 0.043). Twenty-four (40.0%) of the 60 DAIR-treated patients experienced treatment failure, with hip location (OR, 3.273; p = 0.048), delay from prosthesis implantation (OR, 1.012 per month; p = 0.019), pre-surgical CRP level >115 mg/L (OR, 4.800; p = 0.039) and mobile component exchange (OR, 0.302; p = 0.069) constituting additional determinants of outcome. Staphylococcus lugdunensis PJI are difficult-to-treat infections, with pivotal roles of an optimal surgical management.