Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study
| Autor: | D, Rodríguez-Pardo, C, Pigrau, J, Lora-Tamayo, A, Soriano, M D, del Toro, J, Cobo, J, Palomino, G, Euba, M, Riera, M, Sánchez-Somolinos, N, Benito, M, Fernández-Sampedro, L, Sorli, L, Guio, J A, Iribarren, J M, Baraia-Etxaburu, A, Ramos, A, Bahamonde, X, Flores-Sánchez, P S, Corona, J, Ariza, José Miguel, Montejo Baranda |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Male
Microbiology (medical) medicine.medical_specialty Prosthesis-Related Infections medicine.drug_class medicine.medical_treatment Antibiotics Prosthesis Retention Interquartile range Ciprofloxacin Epidemiology medicine Humans prosthetic joint infection Aged Retrospective Studies Aged 80 and over Debridement Proportional hazards model business.industry Arthritis Hazard ratio General Medicine gram-negative bacteria Surgery Anti-Bacterial Agents Treatment Outcome Infectious Diseases Spain Female Implant prognosis business Gram-Negative Bacterial Infections debridement medicine.drug |
| Zdroj: | CLINICAL MICROBIOLOGY AND INFECTION r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname |
| ISSN: | 1198-743X |
| DOI: | 10.1111/1469-0691.12649 |
| Popis: | We aim to evaluate the epidemiology and outcome of gram-negative prosthetic joint infection (GN-PJI) treated with debridement, antibiotics and implant retention (DAIR), identify factors predictive of failure, and determine the impact of ciprofloxacin use on prognosis. We performed a retrospective, multicentre, observational study of GN-PJI diagnosed from 2003 through to 2010 in 16 Spanish hospitals. We define failure as persistence or reappearance of the inflammatory joint signs during follow-up, leading to unplanned surgery or repeat debridement >30 days from the index surgery related death, or suppressive antimicrobial therapy. Parameters predicting failure were analysed with a Cox regression model. A total of 242 patients (33% men; median age 76 years, interquartile range (IQR) 68–81) with 242 episodes of GN-PJI were studied. The implants included 150 (62%) hip, 85 (35%) knee, five (2%) shoulder and two (1%) elbow prostheses. There were 189 (78%) acute infections. Causative microorganisms were Enterobacteriaceae in 78%, Pseudomonas spp. in 20%, and other gram-negative bacilli in 2%. Overall, 19% of isolates were ciprofloxacin resistant. DAIR was used in 174 (72%) cases, with an overall success rate of 68%, which increased to 79% after a median of 25 months' follow-up in ciprofloxacin-susceptible GN-PJIs treated with ciprofloxacin. Ciprofloxacin treatment exhibited an independent protective effect (adjusted hazard ratio (aHR) 0.23; 95% CI, 0.13–0.40; p |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|