Rafael Mahieu1, Vincent Dubée2, Valérie Seegers3, Carole Lemarié4, Séverine Ansart5, Louis Bernard6, Gwenaël Le Moal7, Nathalie Asseray8, Cédric Arvieux9, Céline Ramanantsoa10, Hélène Cormier11, Erick Legrand12, Pierre Abgueguen13. 1. Service de Maladies Infectieuses et Tropicales, CHU Angers, 49933 Angers, France; CRCINA, Inserm, Université de Nantes, Université d'Angers, Angers, France; Equipe ATIP AVENIR, CRCINA, Inserm, Université de Nantes, Université d'Angers, Angers, France. Electronic address: rafael.mahieu@chu-angers.fr. 2. Service de Maladies Infectieuses et Tropicales, CHU Angers, 49933 Angers, France; CRCINA, Inserm, Université de Nantes, Université d'Angers, Angers, France; Equipe ATIP AVENIR, CRCINA, Inserm, Université de Nantes, Université d'Angers, Angers, France. Electronic address: Vincent.Dubee@chu-angers.fr. 3. Institut de Cancérologie de l'Ouest, Biometry Department, Angers, France. Electronic address: Valerie.Seegers@ico.unicancer.fr. 4. Laboratory of Bacteriology, CHU Angers, Angers, France. Electronic address: CaLemarie@chu-angers.fr. 5. Department of Infectious Diseases, Hôpital Universitaire La Cavale Blanche, Brest, France. Electronic address: severine.ansart@chu-brest.fr. 6. CHRU de Tours, Hôpital Bretonneau, Service de Médecine Interne et Maladies Infectieuses, 37044 Tours CEDEX 9, France. Electronic address: L.bernard@chu-tours.fr. 7. Service de Maladies Infectieuses et Tropicales, CHU Poitiers, 86000, Poitiers, France. Electronic address: Gwenael.LE-MOAL@chu-poitiers.fr. 8. Department of Infectious Diseases, Nantes University Hôpital, and CIC 1413, INSERM, Nantes, France. Electronic address: nathalie.asseray@chu-nantes.fr. 9. Service des Maladies Infectieuses, Rennes University Hospital, 2 rue Henri Le Guilloux, 35043 Rennes, France. Electronic address: cedric.arvieux@chu-rennes.fr. 10. Laboratoire de Microbiologie, Centre Hospitalier, Le Mans, France. Electronic address: cramanantsoa@ch-lemans.fr. 11. Service de Maladies Infectieuses et Tropicales, CHU Angers, 49933 Angers, France. Electronic address: Helene.Cormier@chu-angers.fr. 12. Service de Rhumatologie, CHU Angers, Angers, France. Electronic address: ErLegrand@chu-angers.fr. 13. Service de Maladies Infectieuses et Tropicales, CHU Angers, 49933 Angers, France. Electronic address: PiAbgueguen@chu-angers.fr.
Abstract
BACKGROUND: The optimal treatment of streptococcal prosthetic joint infections (PJIs) is unclear. METHODS: A cohort of streptococcal PJIs was reviewed retrospectively in seven reference centers for the management of complex bone and joint infections, covering the period January 1, 2010 to December 31, 2012. RESULTS: Seventy patients with monomicrobial infections were included: 47 had infections of total hip arthroplasty and 23 had infections of total knee arthroplasty. The median age was 77 years (interquartile range (IQR) 69-83 years), the median Charlson comorbidity score was 4 (IQR 3-6), and 15.6% (n=11) had diabetes. The most commonly identified streptococcal species were Streptococcus agalactiae and Streptococcus dysgalactiae (38.6% (n=27) and 17.1% (n=12), respectively). Debridement, antibiotics and implant retention (DAIR) was performed after a median time of 7 days (IQR 3-8 days), with polyethylene exchange (PE) in 21% of cases. After a minimum follow-up of 2 years, 27% of patients had relapsed, corresponding to 51.4% of DAIR treatment cases and 0% of one-stage (n=15) or two-stage (n=17) exchange strategy cases. Rifampicin or levofloxacin in combination therapy was not associated with a better outcome (adjusted p= 0.99). S. agalactiae species and DAIR treatment were associated with a higher risk of failure. On multivariate analysis, only DAIR treatment and S. agalactiae were independent factors of relapse. Compared to DAIR without PE, DAIR with PE was only associated with a trend towards a benefit (odds ratio 0.33, 95% confidence interval 0.06-1.96; adjusted p= 0.44). CONCLUSIONS: Streptococcal PJIs managed with DAIR have a poor prognosis and S. agalactiae seems to be an independent factor of treatment failure.
BACKGROUND: The optimal treatment of streptococcal prosthetic joint infections (PJIs) is unclear. METHODS: A cohort of streptococcal PJIs was reviewed retrospectively in seven reference centers for the management of complex bone and joint infections, covering the period January 1, 2010 to December 31, 2012. RESULTS: Seventy patients with monomicrobial infections were included: 47 had infections of total hip arthroplasty and 23 had infections of total knee arthroplasty. The median age was 77 years (interquartile range (IQR) 69-83 years), the median Charlson comorbidity score was 4 (IQR 3-6), and 15.6% (n=11) had diabetes. The most commonly identified streptococcal species were Streptococcus agalactiae and Streptococcus dysgalactiae (38.6% (n=27) and 17.1% (n=12), respectively). Debridement, antibiotics and implant retention (DAIR) was performed after a median time of 7 days (IQR 3-8 days), with polyethylene exchange (PE) in 21% of cases. After a minimum follow-up of 2 years, 27% of patients had relapsed, corresponding to 51.4% of DAIR treatment cases and 0% of one-stage (n=15) or two-stage (n=17) exchange strategy cases. Rifampicin or levofloxacin in combination therapy was not associated with a better outcome (adjusted p= 0.99). S. agalactiae species and DAIR treatment were associated with a higher risk of failure. On multivariate analysis, only DAIR treatment and S. agalactiae were independent factors of relapse. Compared to DAIR without PE, DAIR with PE was only associated with a trend towards a benefit (odds ratio 0.33, 95% confidence interval 0.06-1.96; adjusted p= 0.44). CONCLUSIONS:Streptococcal PJIs managed with DAIR have a poor prognosis and S. agalactiae seems to be an independent factor of treatment failure.
Authors: Elysia A Masters; Stephanie P Hao; H Mark Kenney; Yugo Morita; Chad A Galloway; Karen L de Mesy Bentley; Benjamin F Ricciardi; Brendan F Boyce; Edward M Schwarz; Irvin Oh Journal: J Orthop Res Date: 2020-12-29 Impact factor: 3.494
Authors: Hye-Kyung Cho; Thao Masters; Kerryl E Greenwood-Quaintance; Stephen Johnson; Patricio R Jeraldo; Nicholas Chia; Meng Pu; Matthew P Abdel; Robin Patel Journal: Microbiologyopen Date: 2021-11 Impact factor: 3.139
Authors: Elysia A Masters; Benjamin F Ricciardi; Karen L de Mesy Bentley; T Fintan Moriarty; Edward M Schwarz; Gowrishankar Muthukrishnan Journal: Nat Rev Microbiol Date: 2022-02-15 Impact factor: 78.297