A Large Multicenter Study of Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus Prosthetic Joint Infections Managed With Implant Retention
A Large Multicenter Study of Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus Prosthetic Joint Infections Managed With Implant Retention
复制标题
DOI：
10.1093/cid/cis746
复制
发表时间：
2013-01-15
影响因子：
11.8
通讯作者：
Ariza, Javier
中科院分区：
文献类型：
--
作者：
Lora-Tamayo, Jaime;Murillo, Oscar;Ariza, Javier
背景资料。已经发表了几个预测葡萄球菌假体关节感染(PJI)预后的系列文章，这些病例采用清创、抗生素和种植体固位(DAIR)治疗，但其中一些结论存在争议。目前，人们对所使用的不同抗生素消除耐甲氧西林金黄色葡萄球菌(MRSA)感染的疗效或能力知之甚少。这是一项对2003-2010年间使用DAIR治疗的金黄色葡萄球菌PJI病例进行的多中心回顾性观察研究。当感染持续/复发、死亡、需要抢救治疗或假体取出时，病例被归类为失败。对预测失败的参数进行Logistic回归和Cox回归分析。在345例(41%男性，73岁)中，81例是由MRSA引起的。52例为血源性，预后较差，88%由甲氧西林敏感的金黄色葡萄球菌(MSSA)引起。抗生素的平均使用时间为93天，在MSSA-和MRSA-PJI中使用基于利福平的联合药物的情况类似。失败发生在45%的病例中，通常在清创后早期。中位生存期1257天。MSSA-PJI和MRSA-PJI的预后没有总体差异，但治疗期间MRSA-PJI治疗失败的发生率较高(HR 2.34)，而治疗后MSSA-PJI治疗失败的发生率较高。以利福平为基础的联合用药显示出独立的保护作用。其他独立预测预后的因素是需要超过1次清创、免疫抑制治疗和更换假体可拆卸部件的多菌感染、炎性感染和细菌性感染。这是迄今为止报道的由DAIR管理的金黄色葡萄球菌最大的PJI系列。成功率为55%。利福平的使用可能有助于均质化MSSA和MRSA的预后，尽管特定的利福平组合可能有不同的疗效。
Background. Several series predicting the prognosis of staphylococcal prosthetic joint infection (PJI) managed with debridement, antibiotics, and implant retention (DAIR) have been published, but some of their conclusions are controversial. At present, little is known regarding the efficacy of the different antibiotics that are used or their ability to eliminate methicillin-resistant S. aureus (MRSA) infection.Methods. This was a retrospective, multicenter, observational study of cases of PJI by S. aureus that were managed with DAIR (2003-2010). Cases were classified as failures when infection persistence/relapse, death, need for salvage therapy, or prosthesis removal occurred. The parameters that predicted failure were analyzed with logistic and Cox regression.Results. Out of 345 episodes (41% men, 73 years), 81 episodes were caused by MRSA. Fifty-two were hematogenous, with poorer prognoses, and 88% were caused by methicillin-susceptible S. aureus (MSSA). Antibiotics were used for a median of 93 days, with similar use of rifampin-based combinations in MSSA- and MRSA-PJI. Failure occurred in 45% of episodes, often early after debridement. The median survival time was 1257 days. There were no overall prognostic differences between MSSA- and MRSA-PJI, but there was a higher incidence of MRSA-PJI treatment failure during the period of treatment (HR 2.34), while there was a higher incidence of MSSA-PJI treatment failure after therapy. Rifampin-based combinations exhibited an independent protective effect. Other independent predictors of outcome were polymicrobial, inflammatory, and bacteremic infections requiring more than 1 debridement, immunosuppressive therapy, and the exchange of removable components of the prosthesis.Conclusions. This is the largest series of PJI by S. aureus managed with DAIR reported to date. The success rate was 55%. The use of rifampin may have contributed to homogenizing MSSA and MRSA prognoses, although the specific rifampin combinations may have had different efficacies.