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Multidrug-resistant and extensively drug-resistant Gram-negative prosthetic joint infections: Role of surgery and impact of colistin administration
- Source :
- International Journal of Antimicrobial Agents. 53:294-301
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- 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.
- Subjects :
- Male
0301 basic medicine
Microbiology (medical)
medicine.medical_specialty
Prosthesis-Related Infections
medicine.drug_class
030106 microbiology
Antibiotics
Drug resistance
medicine.disease_cause
03 medical and health sciences
0302 clinical medicine
Antibiotic resistance
Drug Resistance, Multiple, Bacterial
Gram-Negative Bacteria
medicine
Humans
Pharmacology (medical)
Prospective Studies
030212 general & internal medicine
Aged
Retrospective Studies
Aged, 80 and over
Antiinfective agent
biology
Colistin
business.industry
Pseudomonas aeruginosa
General Medicine
Middle Aged
biology.organism_classification
Survival Analysis
Anti-Bacterial Agents
Surgery
Multiple drug resistance
Treatment Outcome
Infectious Diseases
Female
Gram-Negative Bacterial Infections
business
Enterobacter cloacae
medicine.drug
Subjects
Details
- ISSN :
- 09248579
- Volume :
- 53
- Database :
- OpenAIRE
- Journal :
- International Journal of Antimicrobial Agents
- Accession number :
- edsair.doi.dedup.....eacec55dc92f143c715752d675da1221