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Título: | Multidrug (MDR) and extensively drug resistant (XDR) Gram negative prosthetic joint infections (PJI): Role of surgery and impact of colistin administration |
Autor: | Papadopoulos, Antonios; Ribera, A.; Mavrogenis, Andreas F.; Rodríguez-Pardo, Dolors; Bonnet, Eric; Salles, Mauro José; Toro, María Dolores del CSIC ORCID; Nguyen, Sophie; Blanco-García, Antonio; Skaliczki, Gábor; Soriano, Álex; Benito, Natividad; Petersdorf, Sabine; Pasticci, Maria Bruna; Tattevin, Pierre; Kocak Tufan, Z.; Chan, Monica; O'Connell, Nuala; Pantazis, Nikos; Kyprianou, Aikaterini; Pigrau, Carlos; Megaloikonomos, Panayiotis D.; Senneville, Eric; Ariza, Javier; Papagelopoulos, Panayiotis J.; Giannitsioti, Efthymia | Palabras clave: | Multidrug resistant Extensively drug resistant Gram negative bacteria Bones Prosthetic joint infection Joint infection |
Fecha de publicación: | mar-2019 | Editor: | Elsevier | Citación: | International Journal of Antimicrobial Agents 53(3): 294-301 (2019) | Resumen: | Factors influencing treatment outcome of patients with Gram-negative bacterial (GNB) multidrug-resistant (MDR) and extensively drug-resistant (XDR) prosthetic joint infection (PJIs) were analysed. Data were collected (2000–2015) by 18 centres. Treatment success was analysed by surgery type for PJI, resistance (MDR/XDR) and antimicrobials (colistin/non-colistin) using logistic regression and survival analyses. A total of 131 patients (mean age 73.0 years, 35.9% male, 58.8% with co-morbidities) with MDR (n = 108) or XDR (n = 23) GNB PJI were assessed. The most common pathogens were Escherichia coli (33.6%), Pseudomonas aeruginosa (25.2%), Klebsiella pneumoniae (21.4%) and Enterobacter cloacae (17.6%). Pseudomonas aeruginosa predominated in XDR cases. Isolates were carbapenem-resistant (n = 12), fluoroquinolone-resistant (n = 63) and ESBL-producers (n = 94). Treatment outcome was worse in XDR versus MDR cases (P = 0.018). Success rates did not differ for colistin versus non-colistin in XDR cases (P = 0.657), but colistin was less successful in MDR cases (P = 0.018). Debridement, antibiotics and implant retention (DAIR) (n = 67) was associated with higher failure rates versus non-DAIR (n = 64) (OR = 3.57, 95% CI 1.68–7.58; P < 0.001). Superiority of non-DAIR was confirmed by Kaplan–Meir analysis (HR = 0.36, 95% CI 0.20–0.67) and remained unchangeable by time of infection (early/late), antimicrobial resistance (MDR/XDR) and antimicrobials (colistin/non-colistin) (Breslow–Day, P = 0.737). DAIR is associated with higher failure rates even in early MDR/XDR GNB PJIs versus implant removal. Colistin should be preserved for XDR cases as it is detrimental in MDR infections. | Versión del editor: | https://doi.org/10.1016/j.ijantimicag.2018.10.018 | URI: | http://hdl.handle.net/10261/214664 | DOI: | 10.1016/j.ijantimicag.2018.10.018 | ISSN: | 0924-8579 | E-ISSN: | 1872-7913 |
Aparece en las colecciones: | (IBIS) Artículos |
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