1. Prognosis of unexpected positive intraoperative cultures in arthroplasty revision: A large multicenter cohort
- Author
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Mikel Mancheño-Losa, Jaime Lora-Tamayo, Marta Fernández-Sampedro, Dolors Rodríguez-Pardo, Ernesto Muñoz-Mahamud, Laura Soldevila, Mariona Palou, José María Barbero, María Dolores del Toro, José Antonio Iribarren, Natividad Benito, Beatriz Sobrino, Alicia Rico-Nieto, Laura Guío-Carrión, Lucía Gómez, Rosa Escudero-Sánchez, María José García-País, Alfredo Jover-Sáenz, Julia Praena, Josu Miren Baraia-Etxaburu, Álvaro Auñón, Elena Múñez-Rubio, Oscar Murillo, Javier Cobo Reinoso, Mª Ángeles Meléndez-Carmona, Esther Viedma, Maria Carmen Fariñas, Carlos Salas-Venero, Pablo S. Corona, Mayli Lung, Laura Morata, Alex Soriano, Eva Benavent, Oriol Gasch, Lluís Falgueras, Jose Bravo-Ferrer Acosta, X. Kortajarena, M.A. Goenaga, Libe Asua Mentxaca, Iraia Arteagoitia Colino, Eva Cuchí Burgos, Lluís Font-Vizcarra, Patricia Ruiz Garbajosa, Eva María Romay Lema, Alejandro López-Pardo Pardo, Ferran Pérez-Villar, Alba Bellés-Bellés, Jaime Esteban, and Joaquín García-Cañete
- Subjects
Microbiology (medical) ,Male ,Reoperation ,medicine.medical_specialty ,Prosthesis-Related Infections ,medicine.drug_class ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,Antibiotics ,Arthritis ,Prosthesis ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,business.industry ,Prosthetic joint infection ,medicine.disease ,Prognosis ,Arthroplasty ,Infectious Diseases ,Cohort ,Etiology ,Female ,Aseptic processing ,business - Abstract
Background The positive-intraoperative-cultures-type prosthetic joint infection (PIOC-PJI) is considered when surgical cultures yield microorganisms in presumed aseptic arthroplasty revisions. Herein we assess the risk factors for failure in the largest cohort of PIOC-PJI patients reported to date. Methods A retrospective, observational, multicenter study was performed during 2007–2017. Surgeries leading to diagnose PIOC-PJI included only one-stage procedures with either complete or partial prosthesis revision. Failure was defined as recurrence caused by the same microorganism. Results 203 cases were included (age 72 years, 52% females). Coagulase-negative staphylococci (n = 125, 62%) was the main etiology, but some episodes were caused by virulent bacteria (n = 51, 25%). Prosthesis complete and partial revision was performed in 93 (46%) and 110 (54%) cases, respectively. After a median of 3.4 years, failure occurred in 17 episodes (8.4%, 95%CI 5.3–13.1). Partial revision was an independent predictor of failure (HR 3.63; 95%CI 1.03–12.8), adjusted for gram-negative bacilli (GNB) infection (HR 2.68; 95%CI 0.91–7.89) and chronic renal impairment (HR 2.40; 95%CI 0.90–6.44). Treatment with biofilm-active antibiotics (rifampin/fluoroquinolones) had a favorable impact on infections caused by staphylococci and GNB. Conclusion Overall prognosis of PIOC-PJI is good, but close follow-up is required in cases of partial revision and in infections caused by GNB.
- Published
- 2021