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Title

Multidrug (MDR) and extensively drug resistant (XDR) Gram negative prosthetic joint infections (PJI): Role of surgery and impact of colistin administration

AuthorsPapadopoulos, Antonios; Ribera, A.; Mavrogenis, Andreas F.; Rodríguez-Pardo, Dolors; Bonnet, Eric; Salles, Mauro José; Toro, María Dolores del; Nguyen, Sophie; Blanco-García, Antonio; Skaliczki, Gábor; Soriano, Alejandro; 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
KeywordsMultidrug resistant
Extensively drug resistant
Gram negative bacteria
Bone, joint infection
Prosthetic joint infection
Issue DateMar-2019
PublisherElsevier
CitationInternational Journal of Antimicrobial Agents 53(3): 294-301 (2019)
AbstractFactors 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.
Publisher version (URL)https://doi.org/10.1016/j.ijantimicag.2018.10.018
URIhttp://hdl.handle.net/10261/214664
DOIhttp://dx.doi.org/10.1016/j.ijantimicag.2018.10.018
ISSN0924-8579
E-ISSN1872-7913
Appears in Collections:(IBIS) Artículos
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