Factors affecting outcome in the treatment of streptococcal periprosthetic joint infections: results from a single-centre retrospective cohort study

被引:8
作者
Andronic, Octavian [1 ]
Achermann, Yvonne [2 ,3 ]
Jentzsch, Thorsten [1 ]
Bearth, Flurin [4 ]
Schweizer, Andreas [1 ]
Wieser, Karl [1 ]
Fucentese, Sandro F. [1 ]
Rahm, Stefan [1 ]
Zinkernagel, Annelies S. [2 ,3 ]
Zingg, Patrick O. [1 ]
机构
[1] Univ Zurich, Balgrist Univ Hosp, Dept Orthopaed, Forchstr 340, CH-8008 Zurich, Switzerland
[2] Univ Zurich, Univ Hosp Zurich, Div Infect Dis, Zurich, Switzerland
[3] Univ Zurich, Univ Hosp Zurich, Hosp Epidemiol, Zurich, Switzerland
[4] Univ Zurich, Ramistr 71, CH-8006 Zurich, Switzerland
关键词
Periprosthetic joint infection; PJI; Streptococcus infection; Biofilm; Rifampin; TOTAL KNEE ARTHROPLASTY; IMPLANT RETENTION; BIOFILM FORMATION; FAILURE; RISK;
D O I
10.1007/s00264-020-04722-7
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Purpose To report and analyse factors affecting the outcome of streptococcal periprosthetic joint infections (PJIs). Methods A retrospective analysis of consecutive streptococcal PJIs was performed. Musculoskeletal Infection Society 2013 criteria were used. Outcome was compared with a prospective PJI cohort from the same institution. Results The most common isolated streptococcal species wasStreptococcus dysgalactiae(9/22, 41%) among 22 patients included. Surgical treatment consisted of DAIR (debridement, antibiotics, irrigation and retention) in 12 (55%), one-stage revision arthroplasty in one (4%), two-stage revision arthroplasty in eight (37%) and implant removal in one (4%) patient. An infection free-outcome was achieved in 15 cases (68%), whilst seven (32%) patients failed initial revision and relapsed with the same pathogen, from which six were treated with DAIR and one with one-stage revision arthroplasty. No failures were observed in patients who received a two-stage revision. Failure rates did not differ in the cases treated with rifampin (1/5) from those without 6/17 (p = 0.55). There was no correlation between the length of antibiotic treatment and relapse (p = 0.723). In all failures, a persistent distant infection focus was identified at the time of relapse. Compared with our prospective PJI cohort, relapse rates were significantly higher 32% vs 12% (p < 0.05). Conclusion No correlation with the use of rifampin or length of antibiotic treatment was found. No failures were observed in patients who received a two-stage revision, which may be the surgical treatment of choice. A distant persisting infection focus could be the reason for PJI relapse with recurrent hematogenous seeding in the joint.
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收藏
页码:57 / 63
页数:7
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