Osteosynthesis-associated infection of the lower limbs by multidrug-resistant and extensively drug-resistant Gram-negative bacteria: a multicentre cohort study
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Published:2022-12-21
Issue:6
Volume:7
Page:279-288
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ISSN:2206-3552
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Container-title:Journal of Bone and Joint Infection
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language:en
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Short-container-title:J. Bone Joint Infect.
Author:
Giannitsioti Efthymia, Salles Mauro JoséORCID, Mavrogenis Andreas, Rodriguez-Pardo Dolors, Los-Arcos Ibai, Ribera Alba, Ariza Javier, del Toro María Dolores, Nguyen Sophie, Senneville Eric, Bonnet Eric, Chan Monica, Pasticci Maria BrunaORCID, Petersdorf Sabine, Benito NatividadORCID, O' Connell NualaORCID, Blanco García Antonio, Skaliczki GáborORCID, Tattevin Pierre, Kocak Tufan Zeliha, Pantazis NikolaosORCID, Megaloikonomos Panayiotis D.ORCID, Papagelopoulos Panayiotis, Soriano AlejandroORCID, Papadopoulos Antonios,
Abstract
Abstract. Purpose: The purpose of this study was the clinical and therapeutic assessment of lower-limb
osteosynthesis-associated infection (OAI) by multidrug-resistant (MDR) and
extensively drug-resistant (XDR) Gram-negative bacteria (GNB), which have been
poorly studied to date.
Methods: A prospective multicentre observational study was conducted on
behalf of ESGIAI (the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Implant-Associated Infections).
Factors associated with remission of the infection were evaluated by
multivariate and Cox regression analysis for a 24-month follow-up period.
Results: Patients (n=57) had a history of trauma (87.7 %), tumour
resection (7 %) and other bone lesions (5.3 %). Pathogens included Escherichia coli
(n=16), Pseudomonas aeruginosa (n=14; XDR 50 %), Klebsiella spp. (n=7), Enterobacter spp. (n=9), Acinetobacter spp. (n=5),
Proteus mirabilis (n=3), Serratia marcescens (n=2) and Stenotrophomonas maltophilia (n=1). The prevalence of ESBL (extended-spectrum β-lactamase), fluoroquinolone and
carbapenem resistance were 71.9 %, 59.6 % and 17.5 % respectively.
Most patients (n=37; 64.9 %) were treated with a combination including
carbapenems (n=32) and colistin (n=11) for a mean of 63.3 d. Implant
retention with debridement occurred in early OAI (66.7 %), whereas the
infected device was removed in late OAI (70.4 %) (p=0.008). OAI remission
was achieved in 29 cases (50.9 %). The type of surgery, antimicrobial
resistance and duration of treatment did not significantly influence the
outcome. Independent predictors of the failure to eradicate OAI were
age >60 years (hazard ratio, HR, of 3.875; 95 % confidence interval, CI95 %, of 1.540–9.752; p=0.004) and
multiple surgeries for OAI (HR of 2.822; CI95 % of 1.144–6.963; p=0.024).
Conclusions: Only half of the MDR/XDR GNB OAI cases treated by antimicrobials and
surgery had a successful outcome. Advanced age and multiple surgeries
hampered the eradication of OAI. Optimal therapeutic options remain a challenge.
Publisher
Copernicus GmbH
Subject
Infectious Diseases,Orthopedics and Sports Medicine,Surgery
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