Acute haematogenous prosthetic joint infection: prospective evaluation of medical and surgical management

Rodríguez D ; Pigrau C ; Euba G ; Cobo J ; García-Lechuz J (Universidad de Zaragoza) ; Palomino J ; Ariza J ; Soriano A

Resumen: The optimum treatment for prosthetic joint infections has not been clearly defined. We report our experience of the management of acute haematogenous prosthetic joint infection (AHPJI) in patients during a 3-year prospective study in nine Spanish hospitals. Fifty patients, of whom 30 (60%) were female, with a median age of 76 years, were diagnosed with AHPJI. The median infection-free period following joint replacement was 4.9 years. Symptoms were acute in all cases. A distant previous infection and/or bacteraemia were identified in 48%. The aetiology was as follows: Staphylococcus aureus, 19; Streptococcus spp., 14; Gram-negative bacilli, 12; anaerobes, two; and mixed infections, three. Thirty-four (68%) patients were treated with a conservative surgical approach (CSA) with implant retention, and 16 had prosthesis removal. At 2-year follow-up, 24 (48%) were cured, seven (14%) had relapsed, seven (14%) had died, five (10%) had persistent infection, five had re-infection, and two had an unknown evolution. Overall, the treatment failure rates were 57.8% in staphylococcal infections and 14.3% in streptococcal infections. There were no failures in patients with Gram-negative bacillary. By multivariate analysis, CSA was the only factor independently associated with treatment failure (OR 11.6; 95% CI 1.29–104.8). We were unable to identify any factors predicting treatment failure in CSA patients, although a Gram-negative bacillary aetiology was a protective factor. These data suggest that although conservative surgery was the only factor independently associated with treatment failure, it could be the first therapeutic choice for the management of Gram-negative bacillary and streptococcal AHPJI, and for some cases with acute S. aureus infections.

Idioma: Inglés

DOI: 10.1111/j.1469-0691.2010.03157.x

Año: 2010

Publicado en: Clinical Microbiology and Infection 16, 12 (2010), 1789-1795
ISSN: 1198-743X

Factor impacto JCR: 4.784 (2010)

Categ. JCR: MICROBIOLOGY rank: 17 / 103 = 0.165 (2010) - Q1 - T1
Categ. JCR: INFECTIOUS DISEASES rank: 8 / 57 = 0.14 (2010) - Q1 - T1

Tipo y forma: Article (PostPrint)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)