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Title: Implant Removal in the Management of Prosthetic Joint Infection by Staphylococcus aureus: Outcome and Predictors of Failure in a Large Retrospective Multicenter Study
Author: Gómez Junyent, Joan
Lora-Tamayo Morillo-Velarde, Jaime
Baraia Etxaburu, Josu
Sánchez Somolinos, Mar
Iribarren, José A.
Rodriguez Pardo, Dolors
Praena Segovia, Julia
Sorlí, Luisa
Bahamonde, Alberto
Riera, Melchor
Rico, Alicia
Toro, Maria Dolores del
Morata, Laura
Cobo Reinoso, Javier
Falgueras, Luis
Benito Hernández, M. Natividad de
Muñez Rubio, Elena
Jover Sáenz, Alfredo
Pigrau, Carles
Ariza Cardenal, Javier
Murillo, Oscar
GEIO-SEIMC (Bone and Joint Infection Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology)
REIPI (Spanish Network for Research in Infectious Diseases)
Keywords: Infeccions per estafilococs
Infeccions quirúrgiques
Staphylococcal infections
Surgical wound infection
Issue Date: 26-Jan-2021
Publisher: MDPI
Abstract: Objectives: To compare the characteristics and outcomes of cases with acute prosthetic joint infection (PJI; early post-surgical or hematogenous) by Staphylococcus aureus managed with implant removal (IRm) or debridement and retention (DAIR). To analyze the outcomes of all cases managed with IRm (initially or after DAIR failure). Methods: Retrospective, multicenter, cohort study of PJI by S. aureus (2003-2010). Overall failure included mortality within 60 days since surgery and local failure due to staphylococcal persistence/relapse. Results: 499 cases, 338 initially managed with DAIR, 161 with IRm. Mortality was higher in acute PJI managed initially with IRm compared to DAIR, but not associated with the surgical procedure, after propensity score matching. Underlying conditions, hemiarthroplasty, and methicillin-resistant S. aureus were risk factors for mortality. Finally, 249 cases underwent IRm (88 after DAIR failure); overall failure was 15.6%. Local failure (9.3%) was slightly higher in cases with several comorbidities, but independent of previous DAIR, type of IRm, and rifampin treatment. Conclusions: In a large multicenter study of S. aureus PJI managed with IRm, failure was low, but mortality significant, especially in cases with acute PJI and underlying conditions, but not associated with the IRm itself. Rifampin efficacy was limited in this setting.
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It is part of: Antibiotics, 2021, vol. 10, num. 2
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Appears in Collections:Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

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