Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study

• Published in: Clinical microbiology and infection Vol. 20; no. 11; pp. O911 - O919
• Main Authors: Rodríguez-Pardo, D., Pigrau, C., Lora-Tamayo, J., Soriano, A., del Toro, M.D., Cobo, J., Palomino, J., Euba, G., Riera, M., Sánchez-Somolinos, M., Benito, N., Fernández-Sampedro, M., Sorli, L., Guio, L., Iribarren, J.A., Baraia-Etxaburu, J.M., Ramos, A., Bahamonde, A., Flores-Sánchez, X., Corona, P.S., Ariza, J.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-11-2014; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Arthritis - therapy; Ciprofloxacin; Ciprofloxacin - therapeutic use; Debridement; Enterobacteriaceae; Female; gram-negative bacteria; Gram-Negative Bacterial Infections - therapy; Humans; Male; prognosis; Prosthesis Retention; Prosthesis-Related Infections - therapy; prosthetic joint infection; Pseudomonas; Retrospective Studies; Spain; Treatment Outcome; Spain; gram-negative bacteria; debridement; Ciprofloxacin; prognosis; prosthetic joint infection
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1111/1469-0691.12649

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 <0.001), whereas chronic renal impairment predicted failure (aHR, 2.56; 95% CI, 1.14–5.77; p 0.0232). Our results confirm a 79% success rate in ciprofloxacin-susceptible GN-PJI treated with debridement, ciprofloxacin and implant retention. New therapeutic strategies are needed for ciprofloxacin-resistant PJI.