The Not-So-Good Prognosis of Streptococcal Periprosthetic Joint Infection Managed by Implant Retention: The Results of a Large Multicenter Study

Lora Tamayo J, Senneville Eric, Alba Ribera, Louis Bernard, Michel Dupon, Valerie Zeller, Ho Kwong Li, Cedric Arvieux, Martin Clauss, Ilker Uckay, Dace Vigante, Tristan Ferry, Jose Antonio Iribarren, Trisha N. Peel, Parham Sendi, Nina Gorisek Miksiv, Dolors Rodriguez-Pardo, Maria Dolores del Toro, Marta Fernandez-Sampedro, Ulrike Dapunt Kaisa HuotariJoshua Davis, Julian Palomino, Danielle Neut, Benjamin M. Clark, Thomas Gottlieb, Rihard Trebse, Alex Soriano, Alberto Bahamonde, Laura Guio, Alicia Rico, Mauro J. C. Salles, M. Jose G. Pais, Natividad Benito, Melchor Riera, Lucia Gomez, Craig Aboltins, Jaime Esteban, Juan Pablo Horcajada, Karina O’Connell, Matteo Ferrari, Gabor Skaliczki, Rafael San Juan, Javier Cobo, Mar Sanchez-Somolinos, Antonio Ramos, Efthymia Giannitsioti, Alfredo Jover-Saenz, Josu Mirena Baraia-Etxaburu, Jose Maria Barbero, Peter F. M. Choong, Nathalie Asseray, Severine Ansart , Gwenael Le Moal, Werner Zimmerli, Javier Ariza

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success.

    A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy.

    Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34).

    This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rifampin.
    Original languageEnglish
    Pages (from-to)1742-1752
    Number of pages11
    JournalClinical Infectious Diseases
    Volume64
    Issue number12
    DOIs
    Publication statusPublished - 23 Mar 2017

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