Acute Hematogenous Prosthetic Joint Infection: Prospective Evaluation of Medical and Surgical Management.
Clin Microbiol Infect. 2009 Dec 29;
Authors: Rodríguez D, Pigrau C, Euba G, Cobo J, García-Lechuz J, Palomino J, Riera M, Del Toro MD, Granados A, Ariza X
Abstract The optimum treatment for prosthetic joint infections has not been clearly defined. In this study, our experience in the management of acute hematogenous prosthetic joint infection (AHPJI) is presented by analyzing data from patients with AHPJI prospectively identified during a 3-year period in 9 Spanish hospitals. Fifty patients, 30 (60%) women, median age 76 years, were diagnosed with AHPJI. The median infection-free period following joint replacement was 4.9 years. Symptoms were acute in all cases. A distant previous infection and/or bacteremia was identified in 48%. Etiology: Staphylococcus aureus 19, Streptococcus spp. 14, gram-negative bacilli 12, anaerobes 2, and mixed infections 3. Thirty-four (68%) patients underwent conservative surgical approach (CSA) with implant retention and 16, prosthesis removal. At 2 years follow-up 24 (48%) were cured, 7 (14%) relapsed, 7 (14%) died, 5 (10%) had persistent infection, 5 reinfection, and 2 an unknown evolution. Overall, the failure rate was 57.8% in staphylococcal infections and 14.3% in streptococcal infections. There were no failures in patients with gram-negative bacilli infection. On multivariate analysis, CSA was the only factor independently associated with treatment failure (OR: 11.6; 95% CI, 1.29 to 104.8). We were unable to identify any factors predicting treatment failure in patients treated with CSA, although a gram-negative bacilli etiology was a protective factor. These data suggest that although conservative surgery was the only factor independently associated with treatment failure, it could be the first therapeutic management for gram-negative bacilli, streptococcal AHPJI, and for some cases with short coming S. aureus infections.
PMID: 20047605 [PubMed - as supplied by publisher]