A Large Multicenter Study of Methicillin–Susceptible and Methicillin–Resistant Staphylococcus aureus Prosthetic Joint Infections Managed With Implant Retention
Jaime Lora-Tamayo,Oscar Murillo,José Antonio Iribarren,Alex Soriano,Mar Sánchez-Somolinos,Josu Miren Baraia-Etxaburu,Alicia Rico,Julián Palomino,Dolors Rodríguez-Pardo,Juan Pablo Horcajada,N. Benito,Alberto Bahamonde,A. Granados,María Dolores del Toro,Javier Cobo,Melchor Riera,Antonio Ramos,Alfredo Jover-Sáenz,Javier Ariza,G. Euba,Xavier Cabo,Salvador Pedrero,Miguel Ángel Goenaga,Maitane Elola,Enrique Moreno,Sebastián García-Ramiro,J.C. Martínez-Pastor,Eduard Tornero,Juan M. García-Lechuz,Mercedes Marín,Manuel Villanueva,Iñigo López,Ramón Cisterna,Juan Miguel Santamaría,M. Gomez,Andres Puente,Pedro Cano,Carlos Pigrau,Roger Sordé,Xavier Flores,Luisa Sorlí,Paula González-Miguez,Lluís Puig,María Franco,Marcos Jordán,Pere Coll,Juan Amador-Mellado,Carlos Fuster-Foz,Luis García-Paíno,Isabel Nieto,Miguel A. Muniain,Ana-Isabel Suárez,María Antonia Maseguer,Eduardo Garagorri,Vicente Pintado,Carmen Marinescu,Antonio Ramírez,Elena Múñez,Teresa Álvarez,Rodrigo García,Fernando Barcenilla,Laura Iogna Prat,Ferran Pérez +62 more
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The use of rifampin may have contributed to homogenizing MSSA and MRSA prognoses, although the specific rifampsin combinations may have had different efficacies.Abstract:
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.read more
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Journal ArticleDOI
Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management
TL;DR: This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of S. aureus as a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections.
Journal ArticleDOI
Prosthetic Joint Infection
Aaron J. Tande,Robin Patel +1 more
TL;DR: The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail and an overview of the treatment and prevention of this challenging condition is provided.
Journal ArticleDOI
Methicillin-resistant Staphylococcus aureus: an overview of basic and clinical research.
Nicholas A Turner,Batu K. Sharma-Kuinkel,Stacey A. Maskarinec,Emily M. Eichenberger,Pratik Shah,Manuela Carugati,Manuela Carugati,Thomas L. Holland,Vance G. Fowler,Vance G. Fowler +9 more
TL;DR: An overview of basic and clinical MRSA research is provided and the expansive body of literature on the epidemiology, transmission, genetic diversity, evolution, surveillance and treatment of MRSA is explored.
Journal ArticleDOI
Bacteria antibiotic resistance: New challenges and opportunities for implant‐associated orthopedic infections
Bingyun Li,Thomas J Webster +1 more
TL;DR: The opportunities and challenges in limiting antibiotic resistance through approaches like the development of novel, non‐drug approaches to reduce bacteria functions related to orthopedic implant‐associated infections are highlighted.
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Periprosthetic joint infection
TL;DR: This Review assesses risk factors, preventive measures, diagnoses, clinical features, and treatment options for prosthetic joint infection, and indicates for surgical management have been refined.
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Prosthetic-Joint Infections
TL;DR: This review offers guidance in establishing the diagnosis correctly and an algorithm summarizing the appropriate medical and surgical options for prosthetic joints infections.
Journal ArticleDOI
Role of Rifampin for Treatment of Orthopedic Implant–Related Staphylococcal Infections : A Randomized Controlled Trial
TL;DR: Among patients with stable implants, short duration of infection, and initial debridement, patients able to tolerate long-term therapy with rifampin-ciprofloxacin experienced cure of the infection without removal of the implant.