Introduction
Materials and methods
Definition
Data management and statistics
Results
Characteristics of patients and clinical presentations of the infections
Patients’ characteristics | n = 61 |
---|---|
Sex M/F [n (%)] | 22 (36) / 39 (64) |
Age (years) [med (IQR)] out of 61 patients | 67 (16) |
ASA score [med (IQR)] out of 50 patients | 2 (1) |
BMI kg/m² [mean (SD)] out of 52 patients | 32 (8) |
Underlying disease | |
Diabetes mellitus [n (%)] | 21/59 (36) |
Cirrhosis [n (%)] | 1/59 (2) |
Cancer [n (%)] | 7/59 (12) |
Chronic renal failure [n (%)] | 6/59 (10) |
GFR < 30 mL/min [n (%)] | 4/37 (11) |
Immunosuppressant therapy [n (%)] | 8/57 (14) |
Chronic cardiac disease [n (%)] | 9/47 (19) |
Chronic obstructive pulmonary disease [n (%)] | 2/47 (4) |
Inflammatory rheumatism [n (%)] | 3/59 (5) |
Alcohol abuse | 3/43 (7) |
Hypertension | 21/43 (49) |
Obesity a | 26/52 (50) |
Microbiological characteristics | |
S. agalactiaemono-infection [n (%)] | 39/59 (66) |
Polymicrobial infection [n (%)] | 20/59 (34) |
Staphylococcus aureus [n (%)] out of 20 polymicrobial infections | 11 (55) |
Staphylococcus epidermidis [n (%)] out of 20 polymicrobial infections | 7 (35) |
Enterococcus spp. [n (%)] out of 20 polymicrobial infections | 2 (10) |
Cutibacterium acnes [n (%)] out of 20 polymicrobial infections | 1 (5) |
Gram negative bacilli [n (%)] out of 20 polymicrobial infections | 6 (30) |
Clinical manifestation | |
Fever [n (%)] | 29/51 (57) |
Local inflammation [n (%)] | 35/43 (81) |
Fistula [n (%)] | 15/55 (27) |
Inflammatory biomarkers | |
Leukocytes (G/L) [med (IQR)] out of 37 patients | 8 (10) |
Polymorphonuclear (G/L) [med (IQR)] out of 13 patients | 4 (2) |
CRP (mg/L) [med (IQR)] out of 33 patients | 133 (186) |
Radiological evidence | |
Osteolysis [n (%)] | 3/21 (14) |
Implant loosening [n (%)] | 3/20 (15) |
Luxation [n (%)] | 0/20 (0) |
Per-operative purulent exudate | 20/34 (59) |
Prosthetic device | |
Prosthesis [n (%)] | 47/61 (77) |
Hip arthroplasty [n (%)] | 27/61 (44) |
Knee arthroplasty [n (%)] | 23/61 (38) |
Ankle arthroplasty [n (%)] | 1/61 2(2) |
Osteosynthesis [n (%)] Internal fixation device (medullary nailing device) [n (%)] | 9/61 (15) 3/61 (5) |
Arthrodesis [n (%)] | 1/61 (2) |
Duration between implantation and infection (weeks) | |
≤ 3 months (early infection) [n (%)] | 4/52 (8) |
> 3 months [n (%)] ≤ 2 years (delayed infection) [n (%)] > 2 years (late infection) [n (%)] | 48/52 (92) 23/52 (44) 25/52 (48) |
Infection’s management
Management | [n (%)] |
---|---|
Surgery | |
DAIR [n (%)] Performed on early infection (out of total DAIR) Performed on delayed or late infection | 19/50 (38) 2/18 (11) 16/18 (89) |
One-stage exchange arthroplasty [n (%)] Performed on early infection (out of total One-stage exchange arthroplasty) Performed on delayed or late infection | 18/50 (36) 2/18 (11) 16/18 (89) |
Two-stage exchange arthroplasty [n (%)] | 10/50 (20) |
Bone resection [n (%)] | 1/50 (2) |
Arthrodesis [n (%)] | 1/50 (2) |
Amputation [n (%)] | 1/50 (2) |
Antibiotic therapy | |
Post-operative intravenous (IV) therapy - Cefotaxime [n (%)] - Cefepime [n (%)] - Daptomycin [n (%)] - Ceftobiprole [n (%)] | 13/34 (38) 5/34 (15) 12/34 (35) 5/34 (15) |
IV duration (days) [med (IQR)] out of 33 patients | 6 (7) |
Post-operative per os therapy - Rifampin combined with other antibiotics than Levofloxacina - Levofloxacin combined with other antibiotics than Rifampin or alone - Rifampin-levofloxacin combination | 6/53 (11) 12/53 (23) 31/53 (58) |
Oral treatment duration (weeks) [med (IQR)] out of 54 patients | 12 (8) |
Outcomes with at least 1 year follow-up | n = 41 |
Remission [n (%)] | 26 (63) |
Relapse [n (%)] | 1 (2) |
Reinfection [n (%)] | 5 (12) |
Superinfection [n (%)] | 3 (7) |
Suppressive antibiotic therapy [n (%)] - Amoxicillin (n) - Clindamycin (n) - Doxycycline (n) - Dalbavancin-ertapenem combination (n) | 8/41 (20) 4 1 1 2 |