Determinants of methicillin-susceptible Staphylococcus aureus native bone and joint infection treatment failure: a retrospective cohort study
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- 作者：Florent Valour ; Anissa Bouaziz ; Judith Karsenty ; Florence Ader…
- 关键词：Staphylococcus aureus ; Bone and joint infection ; Treatment failure
- 刊名：BMC Infectious Diseases
- 出版年：2014
- 出版时间：December 2014
- 年：2014
- 卷：14
- 期：1
- 全文大小：459 KB
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文摘
Background Although methicillin-susceptible Staphylococcus aureus (MSSA) native bone and joint infection (BJI) constitutes the more frequent clinical entity of BJI, prognostic studies mostly focused on methicillin-resistant S. aureus prosthetic joint infection. We aimed to assess the determinants of native MSSA BJI outcomes. Methods Retrospective cohort study (2001-011) of patients admitted in a reference hospital centre for native MSSA BJI. Treatment failure determinants were assessed using Kaplan-Meier curves and binary logistic regression. Results Sixty-six patients (42 males [63.6%]; median age 61.2?years; interquartile range [IQR] 45.9-1.9) presented an acute (n--8; 57.6%) or chronic (n--8; 42.4%) native MSSA arthritis (n--5; 22.7%), osteomyelitis (n--9; 28.8%) or spondylodiscitis (n--2; 48.5%), considered as “difficult-to-treat-in 61 cases (92.4%). All received a prolonged (27.1?weeks; IQR, 16.9-6.1) combined antimicrobial therapy, after surgical management in 37 cases (56.1%). Sixteen treatment failures (24.2%) were observed during a median follow-up period of 63.3?weeks (IQR, 44.7-03.1), including 13 persisting infections, 1 relapse after treatment disruption, and 2 super-infections. Independent determinants of treatment failure were the existence of a sinus tract (odds ratio [OR], 5.300; 95% confidence interval [CI], 1.166-4.103) and a prolonged delay to infectious disease specialist referral (OR, 1.134; 95% CI 1.013-.271). Conclusions The important treatment failure rate pinpointed the difficulty of cure encountered in complicated native MSSA BJI. An early infectious disease specialist referral is essential, especially in debilitated patients or in presence of sinus tract.