Outcome of orthopedic implant infections due to different staphylococci

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• 作者：Dorota Teterycz ; Tristan Ferry ; Daniel Lew ; Richard Stern ; Mathieu Assal ; Pierre Hoffmeyer ; Louis Bernard ; Ilker Uç ; kay
• 关键词：Orthopedic ; Implant ; Infection ; Staphylococci ; Outcomes
• 刊名：International Journal of Infectious Diseases
• 出版年：2010
• 出版时间：October 2010
• 年：2010
• 卷：14
• 期：10
• 页码：e913-e918
• 全文大小：138 K

文摘

<h4 class=""h4"">Backgroundh3>Comparisons of different staphylococci in orthopedic implant infections have rarely been reported. In this study we assessed total joint arthroplasty infections and other orthopedic implant infections due to methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant Staphylococcus aureus (MRSA), and coagulase-negative staphylococci (CoNS).<h4 class=""h4"">Methodsh3>

This was a retrospective study performed at the Geneva University Hospitals for the period January 1996 to June 2008.<h4 class=""h4"">Resultsh3>

There were 44 infections due to MRSA, 58 due to MSSA, and 61 due to CoNS. Overall cure was achieved in 57 % (25/44) of MRSA infections, 72 % (42/58) of MSSA infections, and 82 % (50/61) of CoNS infections, after a minimum follow-up of 1 year. In the subgroup of arthroplasty infections only, cure was achieved in 39 % (7/18) of MRSA, 60 % (15/25) of MSSA, and 77 % (30/39) of CoNS episodes. In multivariate analysis, arthroplasty (odds ratio (OR) 0.2, 95 % confidence interval (95 % CI) 0.1–0.6) and MRSA infections (OR 0.3, 95 % CI 0.1–0.9) were inversely associated with overall cure for all implants. CoNS infection (OR 3.0, 95 % CI 1.2–8.0) and the insertion of a new implant (OR 4.5, 95 % CI 1.6–13.1) were associated with higher cure results. Methicillin resistance, immunosuppression, sex, age, duration of antibiotic therapy, one-stage revision, rifampin use, and total number of surgical interventions did not influence cure. MRSA-infected patients had more post-infection sequelae than patients with MSSA or CoNS (Chi-square test 13/44 vs. 93/119, OR 3.4, 95 % CI 1.3–8.9, p = 0.004).<h4 class=""h4"">Conclusionsh3>

In orthopedic implant infections, S. aureus is more virulent than CoNS. MRSA has the worst outcome and CoNS the best.