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Gram-negative prosthetic joint infections managed according to a multidisciplinary standardized approach: risk

O Grossi1, N Asseray2, C Bourigault3

  • 1Service des Maladies Infectieuses, Centre Hospitalier Universitaire, 1 place Alexis Ricordeau, 44093 Nantes cedex 1, France Département de Médecine Interne - Infectiologie, Nouvelles Cliniques Nantaises, 3 rue Eric Tabarly, 44277 Nantes cedex 2, France ogrossi@ncn.fr.

The Journal of Antimicrobial Chemotherapy
|June 10, 2016
PubMed
Abstract

Insights

Standardized treatment for Gram-negative bacilli prosthetic joint infections (GNB-PJIs) shows promising outcomes. High C-reactive protein levels (≥175 mg/L) predict treatment failure, suggesting careful monitoring is crucial for GNB-PJI management.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Pharmacology

Background:

  • Prosthetic joint infections (PJIs) caused by Gram-negative bacilli (GNB) present significant treatment challenges.
  • Standardized treatment protocols are essential for managing GNB-PJIs effectively.

Purpose of the Study:

  • To evaluate the outcomes and identify risk factors for treatment failure in GNB-PJIs managed with curative intent.
  • To assess the efficacy of different antibiotic strategies, including fluoroquinolones and intravenous β-lactams.

Main Methods:

  • A retrospective analysis of 76 patients with GNB-PJI treated surgically over an 8-year period.
  • Treatment failure was defined by persistent/recurrent infection signs, requiring further intervention or leading to death.
  • Multivariate analysis was used to identify predictors of treatment failure.

Main Results:

  • A treatment failure rate of 21.1% (16/76 patients) was observed within a median follow-up of 2.6 years.
  • No significant difference in failure rates was found between fluoroquinolone and non-fluoroquinolone groups.
  • Elevated C-reactive protein levels (≥175 mg/L) were strongly associated with treatment failure (adjusted HR=7.75, P<0.0001).

Conclusions:

  • Standardized management protocols may improve the prognosis of GNB-PJIs.
  • Intravenous β-lactams, administered for 3 months, represent a viable alternative to fluoroquinolones for GNB-PJI treatment.

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