A Large Multicenter Study of Methicillin–Susceptible and Methicillin–Resistant Staphylococcus aureus Prosthetic Joint Infections Managed With Implant Retention
Top Cited Papers
Open Access
- 31 August 2012
- journal article
- research article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 56 (2), 182-194
- https://doi.org/10.1093/cid/cis746
Abstract
Background. Several series predicting the prognosis of staphylococcal prosthetic joint infection (PJI) managed with debridement, antibiotics, and implant retention (DAIR) have been published, but some of their conclusions are controversial. At present, little is known regarding the efficacy of the different antibiotics that are used or their ability to eliminate methicillin-resistant S. aureus (MRSA) infection. Methods. This was a retrospective, multicenter, observational study of cases of PJI by S. aureus that were managed with DAIR (2003–2010). Cases were classified as failures when infection persistence/relapse, death, need for salvage therapy, or prosthesis removal occurred. The parameters that predicted failure were analyzed with logistic and Cox regression. Results. Out of 345 episodes (41% men, 73 years), 81 episodes were caused by MRSA. Fifty-two were hematogenous, with poorer prognoses, and 88% were caused by methicillin-susceptible S. aureus (MSSA). Antibiotics were used for a median of 93 days, with similar use of rifampin-based combinations in MSSA- and MRSA-PJI. Failure occurred in 45% of episodes, often early after debridement. The median survival time was 1257 days. There were no overall prognostic differences between MSSA- and MRSA-PJI, but there was a higher incidence of MRSA-PJI treatment failure during the period of treatment (HR 2.34), while there was a higher incidence of MSSA-PJI treatment failure after therapy. Rifampin-based combinations exhibited an independent protective effect. Other independent predictors of outcome were polymicrobial, inflammatory, and bacteremic infections requiring more than 1 debridement, immunosuppressive therapy, and the exchange of removable components of the prosthesis. Conclusions. This is the largest series of PJI by S. aureus managed with DAIR reported to date. The success rate was 55%. The use of rifampin may have contributed to homogenizing MSSA and MRSA prognoses, although the specific rifampin combinations may have had different efficacies.Keywords
This publication has 28 references indexed in Scilit:
- Prosthetic joint infection: diagnosis and managementExpert Review of Anti-infective Therapy, 2011
- Outcome and predictors of treatment failure in early post-surgical prosthetic joint infections due to Staphylococcus aureus treated with debridementClinical Microbiology & Infection, 2011
- Efficacy and safety of rifampin containing regimen for staphylococcal prosthetic joint infections treated with debridement and retentionEuropean Journal of Clinical Microbiology & Infectious Diseases, 2010
- One hundred and twelve infected arthroplasties treated with 'DAIR' (debridement, antibiotics and implant retention): antibiotic duration and outcomeJournal of Antimicrobial Chemotherapy, 2009
- Outcome of Prosthetic Joint Infections Treated with Debridement and Retention of ComponentsClinical Infectious Diseases, 2006
- Prosthetic Joint InfectionsInfectious Disease Clinics of North America, 2005
- Prosthetic-Joint InfectionsNew England Journal of Medicine, 2004
- Clinical Effectiveness and Cost-Effectiveness of 2 Management Strategies for Infected Total Hip Arthroplasty in the ElderlyClinical Infectious Diseases, 2001
- Staphylococcus aureus Prosthetic Joint Infection Treated with Debridement and Prosthesis RetentionClinical Infectious Diseases, 1997
- Infection after Total Hip Arthroplasty. A Study of the Treatment of One Hundred and Six Infections*The Journal of Bone & Joint Surgery, 1996