S Perez1, F-A Dauchy2, F Salvo3, M Quéroué4, H Durox5, P Delobel6, R Chambault7, M Ade7, C Cazanave1, A Desclaux1, T Fabre8, H Dutronc9. 1. Infectious and tropical disease service, Bordeaux CHU, hôpital Pellegrin, place Amélie Raba-Léon, 33076 Bordeaux, France. 2. Infectious and tropical disease service, Bordeaux CHU, hôpital Pellegrin, place Amélie Raba-Léon, 33076 Bordeaux, France; South Western France referral center for complex bone and joint infections (Crioac GSO), France. 3. Medical pharmacology service, Bordeaux CHU, Bordeaux, France. 4. Informatic unit, medical information service, Bordeaux CHU, Bordeaux, France. 5. South Western France referral center for complex bone and joint infections (Crioac GSO), France; Infectious and tropical disease service, Limoges CHU, Limoges, France. 6. South Western France referral center for complex bone and joint infections (Crioac GSO), France; Infectious and tropical disease service, Toulouse CHU, Toulouse, France. 7. Hospital Pharmacy, Toulouse CHU, Toulouse, France. 8. South Western France referral center for complex bone and joint infections (Crioac GSO), France; Orthopedic surgery service, Bordeaux CHU, Bordeaux, France. 9. Infectious and tropical disease service, Bordeaux CHU, hôpital Pellegrin, place Amélie Raba-Léon, 33076 Bordeaux, France; South Western France referral center for complex bone and joint infections (Crioac GSO), France. Electronic address: herve.dutronc@chu-bordeaux.fr.
Abstract
INTRODUCTION: The management of prosthetic joint infection requires a complex treatment procedure and can be associated with complications. However, the occurrence of severe adverse events during this intervention has been poorly evaluated. PATIENTS AND METHODS: A 5-year multicentric retrospective study including patients from 3 hospitals in the South-Western France referral center for complex bone and joint infections (Crioac GSO) and treated for hip or knee prosthetic joint infection with 1 or 2-stage implant exchanges. The objective was to describe grade≥3 adverse events, according to the CTCAE classification, occurring within 6 weeks after surgery and to identify their associated factors. RESULTS: One hundred and eighteen patients were identified. We observed 71 severe events in 50 patients (42.3%; 95% confidence interval [CI95%]: 33.8-51.4%). Sixteen severe events were an evolution of the infection. The remaining 55 others (47 grade 3 and 8 grade 4) occurred in 41 patients (34.7%; CI95%: 26.8-43.7%). They were distributed as follows: 27 (49.1%) medical complications, 21 (38.2%) surgical complications and 7 (12.7%) antibiotic-related complications. The main identified risk factor was a two-stage prosthetic exchange with OR=3.6 (CI95% [1.11-11.94], P=0.032). Obesity was limit of significance with OR=3.3 (CI95% [0.9-12.51], P=0.071). Infection with coagulase negative Staphylococcus was a protective factor with OR=0.3 (CI95% [0.12-0.99], P=0.047). CONCLUSION: Severe adverse events are frequent following prosthetic exchange for PJI (34.7%) and are related to the high frequency of comorbidities in this population and to the complex surgical procedures required. The risk factor significantly associated with these events was a two-stage exchange.
INTRODUCTION: The management of prosthetic joint infection requires a complex treatment procedure and can be associated with complications. However, the occurrence of severe adverse events during this intervention has been poorly evaluated. PATIENTS AND METHODS: A 5-year multicentric retrospective study including patients from 3 hospitals in the South-Western France referral center for complex bone and joint infections (Crioac GSO) and treated for hip or knee prosthetic joint infection with 1 or 2-stage implant exchanges. The objective was to describe grade≥3 adverse events, according to the CTCAE classification, occurring within 6 weeks after surgery and to identify their associated factors. RESULTS: One hundred and eighteen patients were identified. We observed 71 severe events in 50 patients (42.3%; 95% confidence interval [CI95%]: 33.8-51.4%). Sixteen severe events were an evolution of the infection. The remaining 55 others (47 grade 3 and 8 grade 4) occurred in 41 patients (34.7%; CI95%: 26.8-43.7%). They were distributed as follows: 27 (49.1%) medical complications, 21 (38.2%) surgical complications and 7 (12.7%) antibiotic-related complications. The main identified risk factor was a two-stage prosthetic exchange with OR=3.6 (CI95% [1.11-11.94], P=0.032). Obesity was limit of significance with OR=3.3 (CI95% [0.9-12.51], P=0.071). Infection with coagulase negative Staphylococcus was a protective factor with OR=0.3 (CI95% [0.12-0.99], P=0.047). CONCLUSION: Severe adverse events are frequent following prosthetic exchange for PJI (34.7%) and are related to the high frequency of comorbidities in this population and to the complex surgical procedures required. The risk factor significantly associated with these events was a two-stage exchange.
Authors: Jérôme Grondin; Pierre Menu; Benoit Métayer; Vincent Crenn; Marc Dauty; Alban Fouasson-Chailloux Journal: Antibiotics (Basel) Date: 2021-03-21