Outcome of patients with streptococcal prosthetic joint infections with special reference to rifampicin combinations.
Outcome of patients with streptococcal prosthetic joint infections with special reference to rifampicin combinations.
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DOI：
10.1186/s12879-016-1889-0
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发表时间：
2016-10-13
影响因子：
3.7
通讯作者：
G4 bone and joint infection study group (G4BJIS)
中科院分区：
文献类型：
--
作者：
Fiaux E;Titecat M;Robineau O;Lora-Tamayo J;El Samad Y;Etienne M;Frebourg N;Blondiaux N;Brunschweiler B;Dujardin F;Beltrand E;Loiez C;Cattoir V;Canarelli JP;Hulet C;Valette M;Nguyen S;Caron F;Migaud H;Senneville E;G4 bone and joint infection study group (G4BJIS)
链球菌性人工关节感染（PJIs）患者的结局尚不清楚。我们进行了一项回顾性多中心队列研究，研究对象为因链球菌感染而发生全髋/膝关节假体（THP/TKP）感染的患者。从2001年到2009年。87例平均年龄为69.1 ± 13.7岁的患者中95例链球菌PJI发作（50例THP和45例TKP）符合入选标准。总的来说，95例病例中有55例（57.9%）接受了清创和抗生素治疗（DAIR）的感染种植体保留治疗。分别有52例（54.7%）和28例（29.5%）病例使用了利福平联合用药（包括与左氧氟沙星联合用药）。平均随访895天（IQR：395-1649）后，缓解率为70.5%（67/95）。由于S.无乳失败的比例与其他患者相同（10/37（27.1%）vs 19/58（32.7%）; p = 0.55）。在单变量分析中，抗生素单药治疗、DAIR、利福平联合用药以外的抗生素治疗和TKP均与不良结局相关。与患者结果显著相关的唯一自变量是假体的位置（即，髋关节与膝关节）（OR = 0.19; 95% CI 0.04-0.93; p值0.04）。链球菌性PJIs的预后可能不如以前报道的那么好，特别是对于感染的全膝关节置换术患者。利福平组合，特别是左氧氟沙星，似乎是合适的抗生素方案，这些患者。
Outcome of patients with streptococcal prosthetic joint infections (PJIs) is not well known. We performed a retrospective multicenter cohort study that involved patients with total hip/knee prosthetic joint (THP/TKP) infections due to Streptococcus spp. from 2001 through 2009. Ninety-five streptococcal PJI episodes (50 THP and 45 TKP) in 87 patients of mean age 69.1 ± 13.7 years met the inclusion criteria. In all, 55 out of 95 cases (57.9 %) were treated with debridement and retention of the infected implants with antibiotic therapy (DAIR). Rifampicin-combinations, including with levofloxacin, were used in 52 (54.7 %) and 28 (29.5 %) cases, respectively. After a mean follow-up period of 895 days (IQR: 395–1649), the remission rate was 70.5 % (67/95). Patients with PJIs due to S. agalactiae failed in the same proportion as in the other patients (10/37 (27.1 %) versus 19/58 (32.7 %); p = .55). In the univariate analysis, antibiotic monotherapy, DAIR, antibiotic treatments other than rifampicin-combinations, and TKP were all associated with a worse outcome. The only independent variable significantly associated with the patients’ outcomes was the location of the prosthesis (i.e., hip versus knee) (OR = 0.19; 95 % CI 0.04–0.93; p value 0.04). The prognosis of streptococcal PJIs may not be as good as previously reported, especially for patients with an infected total knee arthroplasty. Rifampicin combinations, especially with levofloxacin, appear to be suitable antibiotic regimens for these patients.
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