Rates and predictors of treatment failure in Staphylococcus aureus prosthetic joint infections according to different management strategies: A multinational cohort study-the ARTHR-IS study group

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• dc.contributor.author Espíndola, Reinaldo
• dc.contributor.author Sorlí, Luisa
• dc.contributor.author ARTHR-IS Group
• dc.date.accessioned 2023-01-30T07:47:35Z
• dc.date.available 2023-01-30T07:47:35Z
• dc.date.issued 2022
• dc.description.abstract Introduction: Guidelines have improved the management of prosthetic joint infections (PJI). However, it is necessary to reassess the incidence and risk factors for treatment failure (TF) of Staphylococcus aureus PJI (SA-PJI) including functional loss, which has so far been neglected as an outcome. Methods: A retrospective cohort study of SA-PJI was performed in 19 European hospitals between 2014 and 2016. The outcome variable was TF, including related mortality, clinical failure and functional loss both after the initial surgical procedure and after all procedures at 18 months. Predictors of TF were identified by logistic regression. Landmark analysis was used to avoid immortal time bias with rifampicin when debridement, antibiotics and implant retention (DAIR) was performed. Results: One hundred twenty cases of SA-PJI were included. TF rates after the first and all surgical procedures performed were 32.8% and 24.2%, respectively. After all procedures, functional loss was 6.0% for DAIR and 17.2% for prosthesis removal. Variables independently associated with TF for the first procedure were Charlson ≥ 2, haemoglobin < 10 g/dL, bacteraemia, polymicrobial infection and additional debridement(s). For DAIR, TF was also associated with a body mass index (BMI) > 30 kg/m2 and delay of DAIR, while rifampicin use was protective. For all procedures, the variables associated with TF were haemoglobin < 10 g/dL, hip fracture and additional joint surgery not related to persistent infection. Conclusions: TF remains common in SA-PJI. Functional loss accounted for a substantial proportion of treatment failures, particularly after prosthesis removal. Use of rifampicin after DAIR was associated with a protective effect. Among the risk factors identified, anaemia and obesity have not frequently been reported in previous studies. Trial registration: This study is registered at clinicaltrials.gov, registration no. NCT03826108.
• dc.description.sponsorship This work was supported by the Innovative Medicines Initiative Joint Undertaking (grant agreement No. 115523), COMBACTE-NET consortium (European Union FP7/2007–2013 and GlaxoSmithKline Biologicals SA, as EFPIA partner). R.E, L.S, O. M, R. E-S, J. L–T, J. P, J. R-B and MD. del T are members of the Spanish Network for Research in Infectious Diseases (REIPI), supported by Plan Nacional de I + D + i 2013‐2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001; 0002; 0005; 0009; 0011; 0015), co‐ financed by European Development Regional Fund “A way to achieve Europe”, Operative Program Intelligence Growth 2014‐2020. The study sponsor is also funding the journal's Rapid Service Fee. Role of funding source: The funders had no influence on the analysis and decision to published; GlaxoSmithKline Biologicals SA was provided the opportunity to review a version of this manuscript for factual accuracy; authors are solely responsible for final content and interpretation.
• dc.format.mimetype application/pdf
• dc.identifier.citation Espíndola R, Vella V, Benito N, Mur I, Tedeschi S, Zamparini E et al. Rates and predictors of treatment failure in Staphylococcus aureus prosthetic joint infections according to different management strategies: A multinational cohort study-the ARTHR-IS study group. Infect Dis Ther. 2022 Dec;11(6):2177-203. DOI: 10.1007/s40121-022-00701-0
• dc.identifier.doi http://dx.doi.org/10.1007/s40121-022-00701-0
• dc.identifier.issn 2193-8229
• dc.identifier.uri http://hdl.handle.net/10230/55471
• dc.language.iso eng
• dc.publisher Springer
• dc.relation.ispartof Infect Dis Ther. 2022 Dec;11(6):2177-203
• dc.relation.projectID info:eu-repo/grantAgreement/EC/FP7/115523
• dc.rights © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
• dc.subject.keyword Clinical failure
• dc.subject.keyword Functional failure
• dc.subject.keyword Outcome
• dc.subject.keyword Prosthetic joint infection
• dc.subject.keyword Staphylococcus aureus
• dc.title Rates and predictors of treatment failure in Staphylococcus aureus prosthetic joint infections according to different management strategies: A multinational cohort study-the ARTHR-IS study group
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion