Rates and Predictors of Treatment Failure in Staphylococcus aureus Prosthetic Joint Infections According to Different Management Strategies: A Multinational Cohort Study—The ARTHR-IS Study Group
Introduction Guidelines have improved the management of prosthetic joint infections (PJI). However, it is necessary to reassess the incidence and risk factors for treatment failure (TF) of Staphylococcus aureus PJI (SA-PJI) including functional loss, which has so far been neglected as an outcome. Me...
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| Veröffentlicht in: | Infectious diseases and therapy 2022-12, Vol.11 (6), p.2177-2203 |
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| creator | Espíndola, Reinaldo Vella, Venanzio Benito, Natividad Mur, Isabel Tedeschi, Sara Zamparini, Eleonora Hendriks, Johannes G. E. Sorlí, Luisa Murillo, Oscar Soldevila, Laura Scarborough, Mathew Scarborough, Claire Kluytmans, Jan Ferrari, Mateo Carlo Pletz, Mathias W. Mcnamara, Iain Escudero-Sanchez, Rosa Arvieux, Cedric Batailler, Cecile Dauchy, Frédéric-Antoine Liu, Wai-Yan Lora-Tamayo, Jaime Praena, Julia Ustianowski, Andrew Cinconze, Elisa Pellegrini, Michele Bagnoli, Fabio Rodríguez-Baño, Jesús del Toro, Maria Dolores |
| description | Introduction
Guidelines have improved the management of prosthetic joint infections (PJI). However, it is necessary to reassess the incidence and risk factors for treatment failure (TF) of
Staphylococcus aureus
PJI (SA-PJI) including functional loss, which has so far been neglected as an outcome.
Methods
A retrospective cohort study of SA-PJI was performed in 19 European hospitals between 2014 and 2016. The outcome variable was TF, including related mortality, clinical failure and functional loss both after the initial surgical procedure and after all procedures at 18 months. Predictors of TF were identified by logistic regression. Landmark analysis was used to avoid immortal time bias with rifampicin when debridement, antibiotics and implant retention (DAIR) was performed.
Results
One hundred twenty cases of SA-PJI were included. TF rates after the first and all surgical procedures performed were 32.8% and 24.2%, respectively. After all procedures, functional loss was 6.0% for DAIR and 17.2% for prosthesis removal. Variables independently associated with TF for the first procedure were Charlson ≥ 2, haemoglobin 30 kg/m
2
and delay of DAIR, while rifampicin use was protective. For all procedures, the variables associated with TF were haemoglobin |
| doi_str_mv | 10.1007/s40121-022-00701-0 |
| format | Article |
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Guidelines have improved the management of prosthetic joint infections (PJI). However, it is necessary to reassess the incidence and risk factors for treatment failure (TF) of
Staphylococcus aureus
PJI (SA-PJI) including functional loss, which has so far been neglected as an outcome.
Methods
A retrospective cohort study of SA-PJI was performed in 19 European hospitals between 2014 and 2016. The outcome variable was TF, including related mortality, clinical failure and functional loss both after the initial surgical procedure and after all procedures at 18 months. Predictors of TF were identified by logistic regression. Landmark analysis was used to avoid immortal time bias with rifampicin when debridement, antibiotics and implant retention (DAIR) was performed.
Results
One hundred twenty cases of SA-PJI were included. TF rates after the first and all surgical procedures performed were 32.8% and 24.2%, respectively. After all procedures, functional loss was 6.0% for DAIR and 17.2% for prosthesis removal. Variables independently associated with TF for the first procedure were Charlson ≥ 2, haemoglobin < 10 g/dL, bacteraemia, polymicrobial infection and additional debridement(s). For DAIR, TF was also associated with a body mass index (BMI) > 30 kg/m
2
and delay of DAIR, while rifampicin use was protective. For all procedures, the variables associated with TF were haemoglobin < 10 g/dL, hip fracture and additional joint surgery not related to persistent infection.
Conclusions
TF remains common in SA-PJI. Functional loss accounted for a substantial proportion of treatment failures, particularly after prosthesis removal. Use of rifampicin after DAIR was associated with a protective effect. Among the risk factors identified, anaemia and obesity have not frequently been reported in previous studies.
Trial registration
This study is registered at clinicaltrials.gov, registration no. NCT03826108.
Graphical abstract
Plain Language Summary
Staphylococcus aureus
is one of the most virulent bacteria and frequently causes prosthetic joint infections.
Knowledge of the treatment of this type of infection has advanced in recent years, and treatment guidelines have led to improved management. Typically, the successful treatment of these infections has been determined by clinical cure, that is, the symptoms of infection have disappeared, but has not taken into account loss of function (such as significant difficulties walking), which is critical for the patient’s quality of life. Our aim in this study was to evaluate the success of current management strategies for
S. aureus
prosthetic joint infection, including recovery of functionality, and the factors that predict why some of these infections are not cured, to identify areas for improvement.
In a multinational cohort of 128 patients with
S. aureus
prosthetic joint infection, rates of treatment failure were found to be high, with significant rates of loss of function, especially when the prosthesis needed to be removed. Loss of function was less frequent when the infection was initially treated with surgical cleaning without removal of the prosthesis, even when this procedure failed at first. We found that anaemia and obesity were associated with lower treatment success, and that the probability of treatment success increased when surgical cleaning without prosthesis removal was performed early, and when the antibiotic rifampicin was used in combination with another antibiotic.</description><identifier>ISSN: 2193-8229</identifier><identifier>EISSN: 2193-6382</identifier><identifier>DOI: 10.1007/s40121-022-00701-0</identifier><identifier>PMID: 36242742</identifier><language>eng</language><publisher>Cheshire: Springer Healthcare</publisher><subject>Anemia ; Antibiotics ; Cohort analysis ; Debridement ; Failure ; Hemoglobin ; Human health and pathology ; Infectious Diseases ; Internal Medicine ; Life Sciences ; Medicine ; Medicine & Public Health ; NCT ; NCT03826108 ; Obesity ; Original Research ; Prostheses ; Quality of life ; Risk factors ; Staphylococcus infections ; Success</subject><ispartof>Infectious diseases and therapy, 2022-12, Vol.11 (6), p.2177-2203</ispartof><rights>The Author(s) 2022</rights><rights>2022. The Author(s).</rights><rights>The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c508t-cc758bcf7ab2fbb4a301929b4256752380731d9693e3da51d32b077d08ee5ae23</citedby><cites>FETCH-LOGICAL-c508t-cc758bcf7ab2fbb4a301929b4256752380731d9693e3da51d32b077d08ee5ae23</cites><orcidid>0000-0001-6732-9001 ; 0000-0003-1938-3905 ; 0000-0001-8157-2753 ; 0000-0001-9546-2811 ; 0000-0002-4935-8754 ; 0000-0002-0455-0785 ; 0000-0001-6410-013X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9669291/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9669291/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,41096,42165,51551,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36242742$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-04022902$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Espíndola, Reinaldo</creatorcontrib><creatorcontrib>Vella, Venanzio</creatorcontrib><creatorcontrib>Benito, Natividad</creatorcontrib><creatorcontrib>Mur, Isabel</creatorcontrib><creatorcontrib>Tedeschi, Sara</creatorcontrib><creatorcontrib>Zamparini, Eleonora</creatorcontrib><creatorcontrib>Hendriks, Johannes G. E.</creatorcontrib><creatorcontrib>Sorlí, Luisa</creatorcontrib><creatorcontrib>Murillo, Oscar</creatorcontrib><creatorcontrib>Soldevila, Laura</creatorcontrib><creatorcontrib>Scarborough, Mathew</creatorcontrib><creatorcontrib>Scarborough, Claire</creatorcontrib><creatorcontrib>Kluytmans, Jan</creatorcontrib><creatorcontrib>Ferrari, Mateo Carlo</creatorcontrib><creatorcontrib>Pletz, Mathias W.</creatorcontrib><creatorcontrib>Mcnamara, Iain</creatorcontrib><creatorcontrib>Escudero-Sanchez, Rosa</creatorcontrib><creatorcontrib>Arvieux, Cedric</creatorcontrib><creatorcontrib>Batailler, Cecile</creatorcontrib><creatorcontrib>Dauchy, Frédéric-Antoine</creatorcontrib><creatorcontrib>Liu, Wai-Yan</creatorcontrib><creatorcontrib>Lora-Tamayo, Jaime</creatorcontrib><creatorcontrib>Praena, Julia</creatorcontrib><creatorcontrib>Ustianowski, Andrew</creatorcontrib><creatorcontrib>Cinconze, Elisa</creatorcontrib><creatorcontrib>Pellegrini, Michele</creatorcontrib><creatorcontrib>Bagnoli, Fabio</creatorcontrib><creatorcontrib>Rodríguez-Baño, Jesús</creatorcontrib><creatorcontrib>del Toro, Maria Dolores</creatorcontrib><creatorcontrib>ARTHR-IS Group</creatorcontrib><creatorcontrib>The ARTHR-IS Group</creatorcontrib><title>Rates and Predictors of Treatment Failure in Staphylococcus aureus Prosthetic Joint Infections According to Different Management Strategies: A Multinational Cohort Study—The ARTHR-IS Study Group</title><title>Infectious diseases and therapy</title><addtitle>Infect Dis Ther</addtitle><addtitle>Infect Dis Ther</addtitle><description>Introduction
Guidelines have improved the management of prosthetic joint infections (PJI). However, it is necessary to reassess the incidence and risk factors for treatment failure (TF) of
Staphylococcus aureus
PJI (SA-PJI) including functional loss, which has so far been neglected as an outcome.
Methods
A retrospective cohort study of SA-PJI was performed in 19 European hospitals between 2014 and 2016. The outcome variable was TF, including related mortality, clinical failure and functional loss both after the initial surgical procedure and after all procedures at 18 months. Predictors of TF were identified by logistic regression. Landmark analysis was used to avoid immortal time bias with rifampicin when debridement, antibiotics and implant retention (DAIR) was performed.
Results
One hundred twenty cases of SA-PJI were included. TF rates after the first and all surgical procedures performed were 32.8% and 24.2%, respectively. After all procedures, functional loss was 6.0% for DAIR and 17.2% for prosthesis removal. Variables independently associated with TF for the first procedure were Charlson ≥ 2, haemoglobin < 10 g/dL, bacteraemia, polymicrobial infection and additional debridement(s). For DAIR, TF was also associated with a body mass index (BMI) > 30 kg/m
2
and delay of DAIR, while rifampicin use was protective. For all procedures, the variables associated with TF were haemoglobin < 10 g/dL, hip fracture and additional joint surgery not related to persistent infection.
Conclusions
TF remains common in SA-PJI. Functional loss accounted for a substantial proportion of treatment failures, particularly after prosthesis removal. Use of rifampicin after DAIR was associated with a protective effect. Among the risk factors identified, anaemia and obesity have not frequently been reported in previous studies.
Trial registration
This study is registered at clinicaltrials.gov, registration no. NCT03826108.
Graphical abstract
Plain Language Summary
Staphylococcus aureus
is one of the most virulent bacteria and frequently causes prosthetic joint infections.
Knowledge of the treatment of this type of infection has advanced in recent years, and treatment guidelines have led to improved management. Typically, the successful treatment of these infections has been determined by clinical cure, that is, the symptoms of infection have disappeared, but has not taken into account loss of function (such as significant difficulties walking), which is critical for the patient’s quality of life. Our aim in this study was to evaluate the success of current management strategies for
S. aureus
prosthetic joint infection, including recovery of functionality, and the factors that predict why some of these infections are not cured, to identify areas for improvement.
In a multinational cohort of 128 patients with
S. aureus
prosthetic joint infection, rates of treatment failure were found to be high, with significant rates of loss of function, especially when the prosthesis needed to be removed. Loss of function was less frequent when the infection was initially treated with surgical cleaning without removal of the prosthesis, even when this procedure failed at first. We found that anaemia and obesity were associated with lower treatment success, and that the probability of treatment success increased when surgical cleaning without prosthesis removal was performed early, and when the antibiotic rifampicin was used in combination with another antibiotic.</description><subject>Anemia</subject><subject>Antibiotics</subject><subject>Cohort analysis</subject><subject>Debridement</subject><subject>Failure</subject><subject>Hemoglobin</subject><subject>Human health and pathology</subject><subject>Infectious Diseases</subject><subject>Internal Medicine</subject><subject>Life Sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>NCT</subject><subject>NCT03826108</subject><subject>Obesity</subject><subject>Original Research</subject><subject>Prostheses</subject><subject>Quality of life</subject><subject>Risk factors</subject><subject>Staphylococcus infections</subject><subject>Success</subject><issn>2193-8229</issn><issn>2193-6382</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>BENPR</sourceid><recordid>eNp9ks9u1DAQxiMEolXpC3BAlrjAIeA_SZxwQFottLtoK6rd5Ww5jpO4ysaL7VTaGw_BI_EkPAmTZinQAyfb49_3zdgzUfSc4DcEY_7WJ5hQEmNKYzhi2D2KTikpWJyxnD4-7nNKi5Po3PsbjIHPE1Lwp9EJy2hCeUJPox9rGbRHsq_QtdOVUcE6j2yNtk7LsNN9QBfSdIPTyPRoE-S-PXRWWaUGUEEYlmtnfWh1MAp9sgYUy77WKhjbezRTyrrK9A0KFn0wda3d6Hkle9noO_tNcFBCY7R_h2boauiC6eUolh2a29a6ERmqw89v37etRrP1drGOl5spiC6dHfbPoie17Lw-P65n0ZeLj9v5Il59vlzOZ6tYpTgPsVI8zUtVc1nSuiwTyTApaFEmNM14SlmOOSNVkRVMs0qmpGK0xJxXONc6lZqys-j95Lsfyp2uFJTvZCf2zuykOwgrjfj3pjetaOytKLIMEhEweD0ZtA9ki9lKjDGcQEMLTG9H9tUxmbNfB-2D2BmvdNfJXtvBC8ppCi1mCQf05QP0xg4OPhCoPOMk4UnGgKITpaBf3un6vgKCxThTYpopASWIu5kSGEQv_n7yveT3BAHAJsDDVd9o9yf3f2x_AZCV2rU</recordid><startdate>20221201</startdate><enddate>20221201</enddate><creator>Espíndola, Reinaldo</creator><creator>Vella, Venanzio</creator><creator>Benito, Natividad</creator><creator>Mur, Isabel</creator><creator>Tedeschi, Sara</creator><creator>Zamparini, Eleonora</creator><creator>Hendriks, Johannes G. 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E. ; Sorlí, Luisa ; Murillo, Oscar ; Soldevila, Laura ; Scarborough, Mathew ; Scarborough, Claire ; Kluytmans, Jan ; Ferrari, Mateo Carlo ; Pletz, Mathias W. ; Mcnamara, Iain ; Escudero-Sanchez, Rosa ; Arvieux, Cedric ; Batailler, Cecile ; Dauchy, Frédéric-Antoine ; Liu, Wai-Yan ; Lora-Tamayo, Jaime ; Praena, Julia ; Ustianowski, Andrew ; Cinconze, Elisa ; Pellegrini, Michele ; Bagnoli, Fabio ; Rodríguez-Baño, Jesús ; del Toro, Maria Dolores</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c508t-cc758bcf7ab2fbb4a301929b4256752380731d9693e3da51d32b077d08ee5ae23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Anemia</topic><topic>Antibiotics</topic><topic>Cohort analysis</topic><topic>Debridement</topic><topic>Failure</topic><topic>Hemoglobin</topic><topic>Human health and pathology</topic><topic>Infectious Diseases</topic><topic>Internal Medicine</topic><topic>Life Sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>NCT</topic><topic>NCT03826108</topic><topic>Obesity</topic><topic>Original Research</topic><topic>Prostheses</topic><topic>Quality of life</topic><topic>Risk factors</topic><topic>Staphylococcus infections</topic><topic>Success</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Espíndola, Reinaldo</creatorcontrib><creatorcontrib>Vella, Venanzio</creatorcontrib><creatorcontrib>Benito, Natividad</creatorcontrib><creatorcontrib>Mur, Isabel</creatorcontrib><creatorcontrib>Tedeschi, Sara</creatorcontrib><creatorcontrib>Zamparini, Eleonora</creatorcontrib><creatorcontrib>Hendriks, Johannes G. E.</creatorcontrib><creatorcontrib>Sorlí, Luisa</creatorcontrib><creatorcontrib>Murillo, Oscar</creatorcontrib><creatorcontrib>Soldevila, Laura</creatorcontrib><creatorcontrib>Scarborough, Mathew</creatorcontrib><creatorcontrib>Scarborough, Claire</creatorcontrib><creatorcontrib>Kluytmans, Jan</creatorcontrib><creatorcontrib>Ferrari, Mateo Carlo</creatorcontrib><creatorcontrib>Pletz, Mathias W.</creatorcontrib><creatorcontrib>Mcnamara, Iain</creatorcontrib><creatorcontrib>Escudero-Sanchez, Rosa</creatorcontrib><creatorcontrib>Arvieux, Cedric</creatorcontrib><creatorcontrib>Batailler, Cecile</creatorcontrib><creatorcontrib>Dauchy, Frédéric-Antoine</creatorcontrib><creatorcontrib>Liu, Wai-Yan</creatorcontrib><creatorcontrib>Lora-Tamayo, Jaime</creatorcontrib><creatorcontrib>Praena, Julia</creatorcontrib><creatorcontrib>Ustianowski, Andrew</creatorcontrib><creatorcontrib>Cinconze, Elisa</creatorcontrib><creatorcontrib>Pellegrini, Michele</creatorcontrib><creatorcontrib>Bagnoli, Fabio</creatorcontrib><creatorcontrib>Rodríguez-Baño, Jesús</creatorcontrib><creatorcontrib>del Toro, Maria Dolores</creatorcontrib><creatorcontrib>ARTHR-IS Group</creatorcontrib><creatorcontrib>The ARTHR-IS Group</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Infectious diseases and therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Espíndola, Reinaldo</au><au>Vella, Venanzio</au><au>Benito, Natividad</au><au>Mur, Isabel</au><au>Tedeschi, Sara</au><au>Zamparini, Eleonora</au><au>Hendriks, Johannes G. E.</au><au>Sorlí, Luisa</au><au>Murillo, Oscar</au><au>Soldevila, Laura</au><au>Scarborough, Mathew</au><au>Scarborough, Claire</au><au>Kluytmans, Jan</au><au>Ferrari, Mateo Carlo</au><au>Pletz, Mathias W.</au><au>Mcnamara, Iain</au><au>Escudero-Sanchez, Rosa</au><au>Arvieux, Cedric</au><au>Batailler, Cecile</au><au>Dauchy, Frédéric-Antoine</au><au>Liu, Wai-Yan</au><au>Lora-Tamayo, Jaime</au><au>Praena, Julia</au><au>Ustianowski, Andrew</au><au>Cinconze, Elisa</au><au>Pellegrini, Michele</au><au>Bagnoli, Fabio</au><au>Rodríguez-Baño, Jesús</au><au>del Toro, Maria Dolores</au><aucorp>ARTHR-IS Group</aucorp><aucorp>The ARTHR-IS Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rates and Predictors of Treatment Failure in Staphylococcus aureus Prosthetic Joint Infections According to Different Management Strategies: A Multinational Cohort Study—The ARTHR-IS Study Group</atitle><jtitle>Infectious diseases and therapy</jtitle><stitle>Infect Dis Ther</stitle><addtitle>Infect Dis Ther</addtitle><date>2022-12-01</date><risdate>2022</risdate><volume>11</volume><issue>6</issue><spage>2177</spage><epage>2203</epage><pages>2177-2203</pages><issn>2193-8229</issn><eissn>2193-6382</eissn><abstract>Introduction
Guidelines have improved the management of prosthetic joint infections (PJI). However, it is necessary to reassess the incidence and risk factors for treatment failure (TF) of
Staphylococcus aureus
PJI (SA-PJI) including functional loss, which has so far been neglected as an outcome.
Methods
A retrospective cohort study of SA-PJI was performed in 19 European hospitals between 2014 and 2016. The outcome variable was TF, including related mortality, clinical failure and functional loss both after the initial surgical procedure and after all procedures at 18 months. Predictors of TF were identified by logistic regression. Landmark analysis was used to avoid immortal time bias with rifampicin when debridement, antibiotics and implant retention (DAIR) was performed.
Results
One hundred twenty cases of SA-PJI were included. TF rates after the first and all surgical procedures performed were 32.8% and 24.2%, respectively. After all procedures, functional loss was 6.0% for DAIR and 17.2% for prosthesis removal. Variables independently associated with TF for the first procedure were Charlson ≥ 2, haemoglobin < 10 g/dL, bacteraemia, polymicrobial infection and additional debridement(s). For DAIR, TF was also associated with a body mass index (BMI) > 30 kg/m
2
and delay of DAIR, while rifampicin use was protective. For all procedures, the variables associated with TF were haemoglobin < 10 g/dL, hip fracture and additional joint surgery not related to persistent infection.
Conclusions
TF remains common in SA-PJI. Functional loss accounted for a substantial proportion of treatment failures, particularly after prosthesis removal. Use of rifampicin after DAIR was associated with a protective effect. Among the risk factors identified, anaemia and obesity have not frequently been reported in previous studies.
Trial registration
This study is registered at clinicaltrials.gov, registration no. NCT03826108.
Graphical abstract
Plain Language Summary
Staphylococcus aureus
is one of the most virulent bacteria and frequently causes prosthetic joint infections.
Knowledge of the treatment of this type of infection has advanced in recent years, and treatment guidelines have led to improved management. Typically, the successful treatment of these infections has been determined by clinical cure, that is, the symptoms of infection have disappeared, but has not taken into account loss of function (such as significant difficulties walking), which is critical for the patient’s quality of life. Our aim in this study was to evaluate the success of current management strategies for
S. aureus
prosthetic joint infection, including recovery of functionality, and the factors that predict why some of these infections are not cured, to identify areas for improvement.
In a multinational cohort of 128 patients with
S. aureus
prosthetic joint infection, rates of treatment failure were found to be high, with significant rates of loss of function, especially when the prosthesis needed to be removed. Loss of function was less frequent when the infection was initially treated with surgical cleaning without removal of the prosthesis, even when this procedure failed at first. We found that anaemia and obesity were associated with lower treatment success, and that the probability of treatment success increased when surgical cleaning without prosthesis removal was performed early, and when the antibiotic rifampicin was used in combination with another antibiotic.</abstract><cop>Cheshire</cop><pub>Springer Healthcare</pub><pmid>36242742</pmid><doi>10.1007/s40121-022-00701-0</doi><tpages>27</tpages><orcidid>https://orcid.org/0000-0001-6732-9001</orcidid><orcidid>https://orcid.org/0000-0003-1938-3905</orcidid><orcidid>https://orcid.org/0000-0001-8157-2753</orcidid><orcidid>https://orcid.org/0000-0001-9546-2811</orcidid><orcidid>https://orcid.org/0000-0002-4935-8754</orcidid><orcidid>https://orcid.org/0000-0002-0455-0785</orcidid><orcidid>https://orcid.org/0000-0001-6410-013X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2193-8229 |
| ispartof | Infectious diseases and therapy, 2022-12, Vol.11 (6), p.2177-2203 |
| issn | 2193-8229 2193-6382 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9669291 |
| source | DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Springer Nature OA Free Journals |
| subjects | Anemia Antibiotics Cohort analysis Debridement Failure Hemoglobin Human health and pathology Infectious Diseases Internal Medicine Life Sciences Medicine Medicine & Public Health NCT NCT03826108 Obesity Original Research Prostheses Quality of life Risk factors Staphylococcus infections Success |
| title | Rates and Predictors of Treatment Failure in Staphylococcus aureus Prosthetic Joint Infections According to Different Management Strategies: A Multinational Cohort Study—The ARTHR-IS Study Group |
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