The Clinical Outcome of Early Periprosthetic Joint Infections Caused by and Managed by Surgical Debridement in an Era of Increasing Resistance

Overview

Journal Antibiotics (Basel)

Specialty Pharmacology

Date 2023 Jan 21

PMID 36671241

Authors

Nada S Shabana

Gesine Seeber

Alex Soriano

Paul C Jutte

Silvia Westermann

Glenn Mithoe

Loredana Pirii

Theke Siebers

Bas Ten Have

Wierd Zijlstra

Djordje Lazovic

Marjan Wouthuyzen-Bakker

Affiliations

Soon will be listed here.

Abstract

Introduction: A risk factor for the failure of surgical debridement in patients with early periprosthetic joint infections (PJI) is the presence of multidrug-resistant microorganisms. Staphylococcus epidermidis is one of the most isolated microorganisms in PJI and is associated with emerging resistance patterns. We aimed to assess the antibiotic resistance patterns of in early PJIs treated with surgical debridement and correlate them to clinical outcomes.

Material And Methods: A retrospective multicentre observational study was conducted to evaluate patients with an early PJI (within 3 months after the index arthroplasty) by with at least two positive intraoperative cultures. Clinical failure was defined as the need for additional surgical intervention or antibiotic suppressive therapy to control the infection.

Results: A total of 157 patients were included. The highest rate of resistance was observed for methicillin in 82% and ciprofloxacin in 65% of the cases. Both were associated with a higher rate of clinical failure (41.2% vs. 12.5% (p 0.048) and 47.3% vs. 14.3% (p 0.015)), respectively. Furthermore, 70% of the cases had reduced susceptibility to vancomycin (MIC ≥ 2), which showed a trend towards a higher failure rate (39.6% vs. 19.0%, NS). Only 7% of the cases were rifampin-resistant. Only the resistance to fluoroquinolones was an independent risk factor for clinical failure in the multivariate analysis (OR 5.45, 95% CI 1.67-17.83).

Conclusion: PJIs show a high rate of resistance. Resistance to fluoroquinolones is associated with clinical failure. Alternative prophylactic antibiotic regimens and optimising treatment strategies are needed to improve clinical outcomes.

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