Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
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
_version_ 1784873122515648512
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
work_keys_str_mv AT shabananadas theclinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT seebergesine theclinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT sorianoalex theclinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT juttepaulc theclinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT westermannsilvia theclinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT mithoeglenn theclinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT piriiloredana theclinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT sieberstheke theclinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT havebasten theclinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT zijlstrawierd theclinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT lazovicdjordje theclinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT wouthuyzenbakkermarjan theclinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT shabananadas clinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT seebergesine clinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT sorianoalex clinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT juttepaulc clinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT westermannsilvia clinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT mithoeglenn clinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT piriiloredana clinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT sieberstheke clinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT havebasten clinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT zijlstrawierd clinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT lazovicdjordje clinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance
AT wouthuyzenbakkermarjan clinicaloutcomeofearlyperiprostheticjointinfectionscausedbystaphylococcusepidermidisandmanagedbysurgicaldebridementinaneraofincreasingresistance