Multidrug-resistant and extensively drug-resistant Gram-negative prosthetic joint infections: Role of surgery and impact of colistin administration.
Int J Antimicrob Agents
; 53(3): 294-301, 2019 Mar.
Article
em En
| MEDLINE
| ID: mdl-30395988
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 (nâ¯=â¯108) or XDR (nâ¯=â¯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 (nâ¯=â¯12), fluoroquinolone-resistant (nâ¯=â¯63) and ESBL-producers (nâ¯=â¯94). Treatment outcome was worse in XDR versus MDR cases (Pâ¯=â¯0.018). Success rates did not differ for colistin versus non-colistin in XDR cases (Pâ¯=â¯0.657), but colistin was less successful in MDR cases (Pâ¯=â¯0.018). Debridement, antibiotics and implant retention (DAIR) (nâ¯=â¯67) was associated with higher failure rates versus non-DAIR (nâ¯=â¯64) (ORâ¯=â¯3.57, 95% CI 1.68-7.58; P < 0.001). Superiority of non-DAIR was confirmed by Kaplan-Meir analysis (HRâ¯=â¯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, Pâ¯=â¯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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Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções Relacionadas à Prótese
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Infecções por Bactérias Gram-Negativas
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Colistina
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Farmacorresistência Bacteriana Múltipla
/
Antibacterianos
Tipo de estudo:
Observational_studies
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Risk_factors_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Int J Antimicrob Agents
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Grécia