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
© 2022. The Author(s)..
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/m2 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:11 |
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| Enthalten in: |
Infectious diseases and therapy - 11(2022), 6 vom: 15. Dez., Seite 2177-2203 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Espíndola, Reinaldo [VerfasserIn] |
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| Links: |
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| Themen: |
Clinical failure |
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| Anmerkungen: |
Date Revised 16.02.2023 published: Print-Electronic ClinicalTrials.gov: NCT03826108 Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1007/s40121-022-00701-0 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM347577334 |
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| 100 | 1 | |a Espíndola, Reinaldo |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Rates and Predictors of Treatment Failure in Staphylococcus aureus Prosthetic Joint Infections According to Different Management Strategies |b A Multinational Cohort Study-The ARTHR-IS Study Group |
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| 500 | |a Date Revised 16.02.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT03826108 | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2022. The Author(s). | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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/m2 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 | ||
| 520 | |a 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 | ||
| 520 | |a TRIAL REGISTRATION: This study is registered at clinicaltrials.gov, registration no. NCT03826108 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Clinical failure | |
| 650 | 4 | |a Functional failure | |
| 650 | 4 | |a Outcome | |
| 650 | 4 | |a Prosthetic joint infection | |
| 650 | 4 | |a Staphylococcus aureus | |
| 700 | 1 | |a Vella, Venanzio |e verfasserin |4 aut | |
| 700 | 1 | |a Benito, Natividad |e verfasserin |4 aut | |
| 700 | 1 | |a Mur, Isabel |e verfasserin |4 aut | |
| 700 | 1 | |a Tedeschi, Sara |e verfasserin |4 aut | |
| 700 | 1 | |a Zamparini, Eleonora |e verfasserin |4 aut | |
| 700 | 1 | |a Hendriks, Johannes G E |e verfasserin |4 aut | |
| 700 | 1 | |a Sorlí, Luisa |e verfasserin |4 aut | |
| 700 | 1 | |a Murillo, Oscar |e verfasserin |4 aut | |
| 700 | 1 | |a Soldevila, Laura |e verfasserin |4 aut | |
| 700 | 1 | |a Scarborough, Mathew |e verfasserin |4 aut | |
| 700 | 1 | |a Scarborough, Claire |e verfasserin |4 aut | |
| 700 | 1 | |a Kluytmans, Jan |e verfasserin |4 aut | |
| 700 | 1 | |a Ferrari, Mateo Carlo |e verfasserin |4 aut | |
| 700 | 1 | |a Pletz, Mathias W |e verfasserin |4 aut | |
| 700 | 1 | |a Mcnamara, Iain |e verfasserin |4 aut | |
| 700 | 1 | |a Escudero-Sanchez, Rosa |e verfasserin |4 aut | |
| 700 | 1 | |a Arvieux, Cedric |e verfasserin |4 aut | |
| 700 | 1 | |a Batailler, Cecile |e verfasserin |4 aut | |
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| 700 | 1 | |a Lora-Tamayo, Jaime |e verfasserin |4 aut | |
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| 700 | 1 | |a Ustianowski, Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a Cinconze, Elisa |e verfasserin |4 aut | |
| 700 | 1 | |a Pellegrini, Michele |e verfasserin |4 aut | |
| 700 | 1 | |a Bagnoli, Fabio |e verfasserin |4 aut | |
| 700 | 1 | |a Rodríguez-Baño, Jesús |e verfasserin |4 aut | |
| 700 | 1 | |a Del Toro, Maria Dolores |e verfasserin |4 aut | |
| 700 | 0 | |a ARTHR-IS Group |e verfasserin |4 aut | |
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| 700 | 1 | |a Pascual-Hernandez, Alvaro |e investigator |4 oth | |
| 700 | 1 | |a Rivera, Alba |e investigator |4 oth | |
| 700 | 1 | |a Crusi, Xavier |e investigator |4 oth | |
| 700 | 1 | |a Jordán, Marcos |e investigator |4 oth | |
| 700 | 1 | |a Rossi, Nicolò |e investigator |4 oth | |
| 700 | 1 | |a Vande Kerkhof, Tessa |e investigator |4 oth | |
| 700 | 1 | |a Horcajada, Juan P |e investigator |4 oth | |
| 700 | 1 | |a Gómez-Junyent, Joan |e investigator |4 oth | |
| 700 | 1 | |a Alier, Albert |e investigator |4 oth | |
| 700 | 1 | |a van Rijen, Miranda |e investigator |4 oth | |
| 700 | 1 | |a Romme, Jannie |e investigator |4 oth | |
| 700 | 1 | |a Ankert, Juliane |e investigator |4 oth | |
| 700 | 1 | |a Whitehouse, Celia |e investigator |4 oth | |
| 700 | 1 | |a Jones, Adrian |e investigator |4 oth | |
| 700 | 1 | |a Cobo, Javier |e investigator |4 oth | |
| 700 | 1 | |a Moreno, Javier |e investigator |4 oth | |
| 700 | 1 | |a Meheut, Anne |e investigator |4 oth | |
| 700 | 1 | |a Gledel, Claire |e investigator |4 oth | |
| 700 | 1 | |a Perreau, Pauline |e investigator |4 oth | |
| 700 | 1 | |a van Wensen, Remco J A |e investigator |4 oth | |
| 700 | 1 | |a Lindergard, Gabriella |e investigator |4 oth | |
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