The not-so-good prognosis of streptococcal periprosthetic joint infection managed by implant retention: The results of a large multicenter study

Jaime Lora-Tamayo, Éric Senneville, Alba Ribera, Louis Bernard, Michel Dupon, Valérie Zeller, Ho Kwong Li, Cédric Arvieux, Martin Clauss, Ilker Uçkay, Dace Vigante, Tristan Ferry, José Antonio Iribarren, Trisha N. Peel, Parham Sendi, Nina Gorišek Miksić, Dolors Rodríguez-Pardo, María Dolores Del Toro, Marta Fernández-Sampedro, Ulrike DapuntKaisa Huotari, Joshua S. Davis, Julián Palomino, Danielle Neut, Benjamin M. Clark, Thomas Gottlieb, Rihard Trebše, Alex Soriano, Alberto Bahamonde, Laura Guío, Alicia Rico, Mauro J.C. Salles, M. José G. Pais, Natividad Benito, Melchor Riera, Lucía Gómez, Craig A. Aboltins, Jaime Esteban, Juan Pablo Horcajada, Karina O'connell, Matteo Ferrari, Gábor Skaliczki, Rafael San Juan, Javier Cobo, Mar Sánchez-Somolinos, Antonio Ramos, Efthymia Giannitsioti, Alfredo Jover-Sáenz, Josu Mirena Baraia-Etxaburu, José María Barbero, Peter F.M. Choong, Nathalie Asseray, Séverine Ansart, Gwenäel Le Moal, Werner Zimmerli, Javier Ariza

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success. Methods. A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy. Results. Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: Failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34). Conclusions. This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rifampin.

Original languageEnglish
Pages (from-to)1742-1752
Number of pages11
JournalClinical Infectious Diseases
Volume64
Issue number12
DOIs
Publication statusPublished - Jun 15 2017
Externally publishedYes

Keywords

  • biofilm
  • bone and joint infection
  • DAIR
  • rifampin.

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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