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Analysis of Prosthetic Joint Infections, Risk Factors for Treatment Failure and Effect of Teicoplanin in Treatment: A
Aybegüm Özşahin1, Zeliha Koçak-Tufan2, Rahmet Güner2
1Department of Infectious Diseases and Clinical Microbiology, Recep Tayyip Erdoğan University, Training and Research Hospital, Rize, Türkiye.
Objective:
This study aimed to identify the risk factors for treatment failure in prosthetic joint infections (PJIs) and the most appropriate approach to these infections, especially the effect of teicoplanin on treatment response.
Materials And Methods:
The data of patients who were followed up with a diagnosis of Gram-positive or culture-negative PJI for seven years in a tertiary-care referral hospital were included in the study retrospectively.
Results:
One hundred sixty-nine PJI attacks were included in the study. The overall infection eradication rate was 82.7%. Preoperative hemoglobin (Hb) and hematocrit (Hct) levels were higher, and C-reactive protein (CRP) levels were lower in treatment responders ( p=0.006, p=0.003, and p=0.021, respectively). The relationship between CRP and treatment response emerged in the second week, while a significant decline in the erythrocyte sedimentation rate (ESR) levels was seen at the end of treatment. Treatment was successful in 91.7% of cases that underwent two-stage revision surgery and 89.4% in those who used teicoplanin for more than two weeks. In multivariate analysis, two-stage revision surgery and the use of teicoplanin for more than two weeks increased treatment success.
Conclusion:
Hb, Hct, and CRP levels could help to predict the treatment response in the preoperative period, and in the postoperative follow-up, CRP could predict the treatment response earlier. Although one-stage surgeries seem practical, the patient's best interests are paramount, and two-stage revisions should be selected whenever needed. Finally, teicoplanin, a practical once-daily, well-tolerated antibiotic, was associated with high treatment success rates in Gram-positive and culture-negative PJIs.
Insights
Identifying risk factors for prosthetic joint infections (PJIs) is crucial. Two-stage revision surgery and longer teicoplanin use significantly improve treatment success rates in PJIs.
Area of Science:
- Orthopedics
- Infectious Diseases
- Pharmacology
Background:
- Prosthetic joint infections (PJIs) pose significant challenges in orthopedic surgery.
- Identifying predictors of treatment failure and optimizing management strategies are critical for patient outcomes.
Purpose of the Study:
- To determine risk factors associated with treatment failure in PJIs.
- To evaluate the effectiveness of different treatment approaches, including the role of teicoplanin.
Main Methods:
- Retrospective analysis of 169 patients with Gram-positive or culture-negative PJIs over seven years.
- Inclusion of preoperative and postoperative clinical and laboratory data, including hemoglobin (Hb), hematocrit (Hct), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).
Main Results:
- An overall infection eradication rate of 82.7% was observed.
- Higher preoperative Hb and Hct, and lower CRP levels were associated with treatment response.
- Two-stage revision surgery and teicoplanin use exceeding two weeks were identified as significant factors for treatment success.
Conclusions:
- Preoperative Hb, Hct, and CRP can predict treatment response, with CRP offering earlier postoperative prediction.
- Two-stage revision surgery is recommended for optimal patient outcomes in PJI management.
- Teicoplanin demonstrates high treatment success rates and is a well-tolerated option for Gram-positive and culture-negative PJIs.
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