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Title: | Osteosynthesis-associated infection of the lower limbs by multidrug-resistant and extensively drug-resistant Gram-negative bacteria: a multicentre cohort study |
Author: | Giannitsioti, Efthymia Salles, Mauro José Mavrogenis, Andreas Rodriguez Pardo, Dolors Los Arcos, Ibai Ribera, Alba Ariza, Javier Toro, María Dolores del Nguyen, Sophie Senneville, Eric Bonnet, Eric Chan, Monica Pasticci, Maria Bruna Petersdorf, Sabine Benito, Natividad O' Connell, Nuala Blanco García, Antonio Skaliczki, Gábor Tattevin, Pierre Kocak Tufan, Zeliha Pantazis, Nikolaos Megaloikonomos, Panayiotis D. Papagelopoulos, Panayiotis Soriano, Alejandro Papadopoulos, Antonios ESGIAI collaborators study group |
Keywords: | Bacteris gramnegatius Drug resistance Osteosíntesi Gram-negative bacteria Resistència als medicaments Osteosynthesis |
Issue Date: | 21-Dec-2022 |
Publisher: | Copernicus GmbH |
Abstract: | Purpose: The purpose of this study was the clinical and therapeutic assessment of lower-limb osteosynthesis-associated infection (OAI) by multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria (GNB), which have been poorly studied to date. Methods: A prospective multicentre observational study was conducted on behalf of ESGIAI (the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Implant-Associated Infections). Factors associated with remission of the infection were evaluated by multivariate and Cox regression analysis for a 24-month follow-up period. Results: Patients ( n = 57) had a history of trauma (87.7 %), tumour resection (7 %) and other bone lesions (5.3 %). Pathogens included Escherichia coli ( n = 16), Pseudomonas aeruginosa ( n = 14; XDR 50 %), Klebsiella spp. ( n = 7), Enterobacter spp. ( n = 9), Acinetobacter spp. ( n D 5), Proteus mirabilis ( n = 3), Serratia marcescens ( n = 2) and Stenotrophomonas maltophilia ( n = 1). The prevalence of ESBL (extended-spectrum fi -lactamase), fluoroquinolone and carbapenem resistance were 71.9 %, 59.6% and 17.5% respectively. Most patients ( n = 37; 64.9 %) were treated with a combination including carbapenems ( n = 32) and colistin ( n = 11) for a mean of 63.3 d. Implant retention with debridement occurred in early OAI (66.7 %), whereas the infected device was removed in late OAI (70.4 %) ( p = 0.008). OAI remission was achieved in 29 cases (50.9 %). The type of surgery, antimicrobial resistance and duration of treatment did not significantly influence the outcome. Independent predictors of the failure to eradicate OAI were age > 60 years (hazard ratio, HR, of 3.875; 95% confidence interval, CI95 %, of 1.540-9.752; p D 0 :004) and multiple surgeries for OAI (HR of 2.822; CI95% of 1.144-6.963; p = 0.024). Conclusions: Only half of the MDR/XDR GNB OAI cases treated by antimicrobials and surgery had a successful outcome. Advanced age and multiple surgeries hampered the eradication of OAI. Optimal therapeutic options remain a challenge. |
Note: | Reproducció del document publicat a: https://doi.org/10.5194/jbji-7-279-2022 |
It is part of: | Journal of Bone and Joint Infection, 2022, vol. 7, num. 6, p. 279-288 |
URI: | http://hdl.handle.net/2445/200876 |
Related resource: | https://doi.org/10.5194/jbji-7-279-2022 |
ISSN: | 2206-3552 |
Appears in Collections: | Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) |
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