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Title: The Not-So-Good Prognosis of Streptococcal Periprosthetic Joint Infection Managed by Implant Retention: The Results of a Large Multicenter Study.
Authors: Lora-Tamayo, Jaime
Senneville, Éric
Ribera, Alba
Bernard, Louis
Dupon, Michel
Zeller, Valérie
Li, Ho Kwong
Arvieux, Cédric
Clauss, Martin
Uçkay, Ilker
Vigante, Dace
Ferry, Tristan
Iribarren, José Antonio
Peel, Trisha N
Sendi, Parham
Miksic, Nina Gorišek
Rodríguez-Pardo, Dolors
Del Toro, María Dolores
Fernández-Sampedro, Marta
Dapunt, Ulrike
Huotari, Kaisa
Davis, Joshua S
Palomino, Julián
Neut, Danielle
Clark, Benjamin M
Gottlieb, Thomas
Trebše, Rihard
Soriano, Alex
Bahamonde, Alberto
Guío, Laura
Rico, Alicia
Salles, Mauro J C
Pais, M José G
Benito, Natividad
Riera, Melchor
Gómez, Lucía
Aboltins, Craig A
Esteban, Jaime
Horcajada, Juan Pablo
O'Connell, Karina
Ferrari, Matteo
Skaliczki, Gábor
Juan, Rafael San
Cobo, Javier
Sánchez-Somolinos, Mar
Ramos, Antonio
Giannitsioti, Efthymia
Jover-Sáenz, Alfredo
Baraia-Etxaburu, Josu Mirena
Barbero, José María
Choong, Peter F M
Asseray, Nathalie
Ansart, Séverine
Moal, Gwenäel Le
Zimmerli, Werner
Ariza, Javier
Group of Investigators for Streptococcal Prosthetic Joint Infection
Keywords: DAIR;biofilm;bone and joint infection;rifampin.
metadata.dc.subject.mesh: Aged
Anti-Bacterial Agents
Arthritis, Infectious
Prosthesis-Related Infections
Retrospective Studies
Salvage Therapy
Streptococcal Infections
Streptococcus agalactiae
Treatment Failure
Issue Date: 2017
Abstract: 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. 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. 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). 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.
metadata.dc.identifier.doi: 10.1093/cid/cix227
Appears in Collections:Producción 2020

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