Interest in the combination of antimicrobial therapy for orthopaedic device-related infections due to Enterococcus spp.
Introduction The objective of this study was to evaluate the management of orthopaedic device-related infections (ODRIs) due to Enterococcus spp. Materials and methods We performed a retrospective cohort study in a French tertiary university hospital. Patients with prosthetic joint- or osteosynthesis-associated infections caused by enterococci from 2013 to 2020 were included. Patients who died within 5 days after surgery; who were in palliative care; or who had osteosynthesis of the hand, foot or vertebra were excluded. Results Thirty-six patients were included, with 24 in the arthroplasty group and 12 in the osteosynthesis material group. Most infections were polymicrobial (63.9%, n = 23). Debridement, antibiotics and implant retention (DAIR) was performed in 30.6% (n = 11), withdrawal of material in 16.7% (n = 6), one-stage exchange in 30.6% (n = 11) and two-stage exchange in 22.2% of cases (n = 8). The antibiotic regimen was amoxicillin in 41.6% (n = 15), rifampicin in 27.8% (n = 10), linezolid in 25% (n = 9) and/or fluoroquinolones in 30.6% (n = 11). Clinical success at 1 year was 67% (18/27). The only variable statistically associated with a decreased risk of clinical failure was a duration of antibiotic therapy of 12 weeks (p = 0.04). Patients with a lower body mass index and age tended to decrease the risk of clinical failure (p = 0.05 and 0.06 respectively). Conclusions The management of enterococcal ODRIs is complex, and ODRI patients are at high risk for relapse. In our small study, a better outcome was not demonstrated for patients with combination therapy and rifampicin use. Further studies are needed to improve the medico-surgical strategy for treating these infections..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:143 |
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| Enthalten in: |
Archives of orthopaedic and trauma surgery - 143(2023), 9 vom: 29. März, Seite 5515-5526 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Maurille, Charles [VerfasserIn] |
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| Links: |
Volltext [lizenzpflichtig] |
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| Themen: |
Outcome |
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| Anmerkungen: |
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. |
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| doi: |
10.1007/s00402-023-04848-4 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 520 | |a Introduction The objective of this study was to evaluate the management of orthopaedic device-related infections (ODRIs) due to Enterococcus spp. Materials and methods We performed a retrospective cohort study in a French tertiary university hospital. Patients with prosthetic joint- or osteosynthesis-associated infections caused by enterococci from 2013 to 2020 were included. Patients who died within 5 days after surgery; who were in palliative care; or who had osteosynthesis of the hand, foot or vertebra were excluded. Results Thirty-six patients were included, with 24 in the arthroplasty group and 12 in the osteosynthesis material group. Most infections were polymicrobial (63.9%, n = 23). Debridement, antibiotics and implant retention (DAIR) was performed in 30.6% (n = 11), withdrawal of material in 16.7% (n = 6), one-stage exchange in 30.6% (n = 11) and two-stage exchange in 22.2% of cases (n = 8). The antibiotic regimen was amoxicillin in 41.6% (n = 15), rifampicin in 27.8% (n = 10), linezolid in 25% (n = 9) and/or fluoroquinolones in 30.6% (n = 11). Clinical success at 1 year was 67% (18/27). The only variable statistically associated with a decreased risk of clinical failure was a duration of antibiotic therapy of 12 weeks (p = 0.04). Patients with a lower body mass index and age tended to decrease the risk of clinical failure (p = 0.05 and 0.06 respectively). Conclusions The management of enterococcal ODRIs is complex, and ODRI patients are at high risk for relapse. In our small study, a better outcome was not demonstrated for patients with combination therapy and rifampicin use. Further studies are needed to improve the medico-surgical strategy for treating these infections. | ||
| 650 | 4 | |a Outcome |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Periprosthetic joint infection |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Total hip arthroplasty |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Total knee arthroplasty |7 (dpeaa)DE-He213 | |
| 700 | 1 | |a Michon, Jocelyn |4 aut | |
| 700 | 1 | |a Isnard, Christophe |4 aut | |
| 700 | 1 | |a Rochcongar, Goulven |4 aut | |
| 700 | 1 | |a Verdon, Renaud |4 aut | |
| 700 | 1 | |a Baldolli, Aurélie |4 aut | |
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