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The Clinical Outcome of Early Periprosthetic Joint Infections Caused by Staphylococcus epidermidis and Managed by Surgical Debridement in an Era of Increasing Resistance
Introduction: A risk factor for the failure of surgical debridement in patients with early periprosthetic joint infections (PJI) is the presence of multidrug-resistant microorganisms. Staphylococcus epidermidis is one of the most isolated microorganisms in PJI and is associated with emerging resista...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9854449/ https://www.ncbi.nlm.nih.gov/pubmed/36671241 http://dx.doi.org/10.3390/antibiotics12010040 |
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author | Shabana, Nada S. Seeber, Gesine Soriano, Alex Jutte, Paul C. Westermann, Silvia Mithoe, Glenn Pirii, Loredana Siebers, Théke Have, Bas ten Zijlstra, Wierd Lazovic, Djordje Wouthuyzen-Bakker, Marjan |
author_facet | Shabana, Nada S. Seeber, Gesine Soriano, Alex Jutte, Paul C. Westermann, Silvia Mithoe, Glenn Pirii, Loredana Siebers, Théke Have, Bas ten Zijlstra, Wierd Lazovic, Djordje Wouthuyzen-Bakker, Marjan |
author_sort | Shabana, Nada S. |
collection | PubMed |
description | Introduction: A risk factor for the failure of surgical debridement in patients with early periprosthetic joint infections (PJI) is the presence of multidrug-resistant microorganisms. Staphylococcus epidermidis is one of the most isolated microorganisms in PJI and is associated with emerging resistance patterns. We aimed to assess the antibiotic resistance patterns of S. epidermidis in early PJIs treated with surgical debridement and correlate them to clinical outcomes. Material and Methods: A retrospective multicentre observational study was conducted to evaluate patients with an early PJI (within 3 months after the index arthroplasty) by S. epidermidis with at least two positive intraoperative cultures. Clinical failure was defined as the need for additional surgical intervention or antibiotic suppressive therapy to control the infection. Results: A total of 157 patients were included. The highest rate of resistance was observed for methicillin in 82% and ciprofloxacin in 65% of the cases. Both were associated with a higher rate of clinical failure (41.2% vs. 12.5% (p 0.048) and 47.3% vs. 14.3% (p 0.015)), respectively. Furthermore, 70% of the cases had reduced susceptibility to vancomycin (MIC ≥ 2), which showed a trend towards a higher failure rate (39.6% vs. 19.0%, NS). Only 7% of the cases were rifampin-resistant. Only the resistance to fluoroquinolones was an independent risk factor for clinical failure in the multivariate analysis (OR 5.45, 95% CI 1.67–17.83). Conclusion: S. epidermidis PJIs show a high rate of resistance. Resistance to fluoroquinolones is associated with clinical failure. Alternative prophylactic antibiotic regimens and optimising treatment strategies are needed to improve clinical outcomes. |
format | Online Article Text |
id | pubmed-9854449 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-98544492023-01-21 The Clinical Outcome of Early Periprosthetic Joint Infections Caused by Staphylococcus epidermidis and Managed by Surgical Debridement in an Era of Increasing Resistance Shabana, Nada S. Seeber, Gesine Soriano, Alex Jutte, Paul C. Westermann, Silvia Mithoe, Glenn Pirii, Loredana Siebers, Théke Have, Bas ten Zijlstra, Wierd Lazovic, Djordje Wouthuyzen-Bakker, Marjan Antibiotics (Basel) Article Introduction: A risk factor for the failure of surgical debridement in patients with early periprosthetic joint infections (PJI) is the presence of multidrug-resistant microorganisms. Staphylococcus epidermidis is one of the most isolated microorganisms in PJI and is associated with emerging resistance patterns. We aimed to assess the antibiotic resistance patterns of S. epidermidis in early PJIs treated with surgical debridement and correlate them to clinical outcomes. Material and Methods: A retrospective multicentre observational study was conducted to evaluate patients with an early PJI (within 3 months after the index arthroplasty) by S. epidermidis with at least two positive intraoperative cultures. Clinical failure was defined as the need for additional surgical intervention or antibiotic suppressive therapy to control the infection. Results: A total of 157 patients were included. The highest rate of resistance was observed for methicillin in 82% and ciprofloxacin in 65% of the cases. Both were associated with a higher rate of clinical failure (41.2% vs. 12.5% (p 0.048) and 47.3% vs. 14.3% (p 0.015)), respectively. Furthermore, 70% of the cases had reduced susceptibility to vancomycin (MIC ≥ 2), which showed a trend towards a higher failure rate (39.6% vs. 19.0%, NS). Only 7% of the cases were rifampin-resistant. Only the resistance to fluoroquinolones was an independent risk factor for clinical failure in the multivariate analysis (OR 5.45, 95% CI 1.67–17.83). Conclusion: S. epidermidis PJIs show a high rate of resistance. Resistance to fluoroquinolones is associated with clinical failure. Alternative prophylactic antibiotic regimens and optimising treatment strategies are needed to improve clinical outcomes. MDPI 2022-12-27 /pmc/articles/PMC9854449/ /pubmed/36671241 http://dx.doi.org/10.3390/antibiotics12010040 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Shabana, Nada S. Seeber, Gesine Soriano, Alex Jutte, Paul C. Westermann, Silvia Mithoe, Glenn Pirii, Loredana Siebers, Théke Have, Bas ten Zijlstra, Wierd Lazovic, Djordje Wouthuyzen-Bakker, Marjan The Clinical Outcome of Early Periprosthetic Joint Infections Caused by Staphylococcus epidermidis and Managed by Surgical Debridement in an Era of Increasing Resistance |
title | The Clinical Outcome of Early Periprosthetic Joint Infections Caused by Staphylococcus epidermidis and Managed by Surgical Debridement in an Era of Increasing Resistance |
title_full | The Clinical Outcome of Early Periprosthetic Joint Infections Caused by Staphylococcus epidermidis and Managed by Surgical Debridement in an Era of Increasing Resistance |
title_fullStr | The Clinical Outcome of Early Periprosthetic Joint Infections Caused by Staphylococcus epidermidis and Managed by Surgical Debridement in an Era of Increasing Resistance |
title_full_unstemmed | The Clinical Outcome of Early Periprosthetic Joint Infections Caused by Staphylococcus epidermidis and Managed by Surgical Debridement in an Era of Increasing Resistance |
title_short | The Clinical Outcome of Early Periprosthetic Joint Infections Caused by Staphylococcus epidermidis and Managed by Surgical Debridement in an Era of Increasing Resistance |
title_sort | clinical outcome of early periprosthetic joint infections caused by staphylococcus epidermidis and managed by surgical debridement in an era of increasing resistance |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9854449/ https://www.ncbi.nlm.nih.gov/pubmed/36671241 http://dx.doi.org/10.3390/antibiotics12010040 |
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