Multidrug (mdr) and extensively drug resistant (xdr) gram negative prosthetic joint infections (pji): role of surgery and impact of colistin administration - Université de Lille Accéder directement au contenu
Article Dans Une Revue International Journal of Antimicrobial Agents Année : 2019

Multidrug (mdr) and extensively drug resistant (xdr) gram negative prosthetic joint infections (pji): role of surgery and impact of colistin administration

Antonios Papadopoulos
  • Fonction : Auteur
Alba Ribera
  • Fonction : Auteur
Andreas Mavrogenis
  • Fonction : Auteur
Dolors Rodriguez-Pardo
  • Fonction : Auteur
Mauro Jose Salles
  • Fonction : Auteur
Maria Dolores del Toro
  • Fonction : Auteur
Antonio Blanco Garcia
  • Fonction : Auteur
Gabor Skaliczki
  • Fonction : Auteur
Alejandro Soriano
  • Fonction : Auteur
Natividad Benito
  • Fonction : Auteur
Sabine Petersdorf
  • Fonction : Auteur
Maria Bruna Pasticci
  • Fonction : Auteur
Zeliha Kocak Tufan
  • Fonction : Auteur
Monica Chan
  • Fonction : Auteur
Nuala O'Connell
  • Fonction : Auteur
Nikos Pantazis
  • Fonction : Auteur
Aikaterini Kyprianou
  • Fonction : Auteur
Carlos Pigrau
  • Fonction : Auteur
Panayiotis Megaloikonomos
  • Fonction : Auteur
Javier Ariza Cardenal
  • Fonction : Auteur
Panayiotis Papagelopoulos
  • Fonction : Auteur
Efthymia Giannitsioti
  • Fonction : Auteur

Résumé

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.
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Dates et versions

hal-04586615 , version 1 (24-05-2024)

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Antonios Papadopoulos, Alba Ribera, Andreas Mavrogenis, Dolors Rodriguez-Pardo, Eric Bonnet, et al.. Multidrug (mdr) and extensively drug resistant (xdr) gram negative prosthetic joint infections (pji): role of surgery and impact of colistin administration. International Journal of Antimicrobial Agents, 2019, International Journal of Antimicrobial Agents, 53, pp.294-301. ⟨10.1016/j.ijantimicag.2018.10.018⟩. ⟨hal-04586615⟩
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