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
The ARTHR-IS Group
(2022) Infectious Diseases and Therapy, volume 11, issue 6, pp. 2177 - 2203
(Article)
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
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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. Graphical abstract: [Figure not available: see fulltext.]
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Keywords: Clinical failure, Functional failure, Outcome, Prosthetic joint infection, Staphylococcus aureus, Staphylococcus aureus, Microbiology (medical), Infectious Diseases, Journal Article
ISSN: 2193-8229
Publisher: Springer Healthcare
Note: Funding Information: We thank all study participants for their collaboration, without which this manuscript would have been impossible. Other members of the ARTHR-IS group are: Nienke Cuperus and Giuseppe Manfré (Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands) collaborated in the selection process of the participating centers. Ana Isabel Suárez-Barrenechea and Alvaro Pascual-Hernandez (Department of microbiology, Hospital Universitario Virgen Macarena), Alba Rivera (Deparment of Microbiology, Hospital de la Santa Creu i Sant Pau), Xavier Crusi and Marcos Jordán (Department of traumatology, Hospital de la Santa Creu i Sant Pau), Nicolò Rossi (Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy), Tessa van de Kerkhof (Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital, Eindhoven, the Netherlands), Juan P. Horcajada, Joan Gómez-Junyent and Albert Alier (Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Pompeu Fabra, Barcelona, Spain), Miranda van Rijen and Jannie Romme (Amphia Hospital, Breda, Netherlands), Juliane Ankert (Jena University Hospital—Jena, Germany), Celia Whitehouse and Adrian Jones (Norfolk and Norwich University Hospital—Norwich, UK), Javier Cobo and Javier Moreno (Hospital Universitario Ramón y Cajal—Madrid, Spain), Anne Meheut (Centre Hospitalier Universitaire de Rennes—Rennes, France), Claire Gledel (Orthopedic surgery department, Croix Rousse Hospital—Lyon, France), Pauline Perreau (Centre Hospitalier Universitaire de Bordeaux—Bordeaux, France), Remco J.A. van Wensen (Department of Orthopaedic Surgery & Trauma, Catharina Hospital, Eindhoven, the Netherland), Gabriella Lindergard (North Manchester General Hospital—Manchester, UK) collaborated in the data collection. 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. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Espindola R, Vella V, Rodríguez-Baño J, Del Toro MD contributed in the conception and design of the study, analysis and interpretation of data and drafting the article. Benito N, Mur I, Tedeschi S, Zamparini E, Hendriks J, Sorlí L, Murillo O, Soldevila L, Scarborough M, Scarborough C, Kluytmans J, Ferrari MC, Pletz M, Mcnamara I, Escudero-Sanchez R, Arvieux C, Batailler C, Dauchy F-A, Liu W-Y, Lora-Tamayo J, Praena J, Ustianowski J contributed in the acquisition of data and revising the article. Cinconze E, Pellegrini M and Bagnoli F participated in the analysis and interpretation of data and revision the article. All authors gave their final approval of the version to be submitted. This study was previously presented as a poster at the 32nd European Congress of Clinical Microbiology & Infectious Diseases (ECCMIC), held in Lisbon, Portugal, April 23–26. Venanzio Vella, Elisa Cinconze, Michele Pellegrini and Fabio Bagnoli are employees of the GSK group of companies. Venanzio Vella, Michele Pellegrini and Fabio Bagnoli hold shares in the GSK group of companies. Fabio Bagnoli holds patents pending and issued patents on Staphylococcus aureus vaccine formulations. Venanzio Vella, Elisa Cinconze, Michele Pellegrini and Fabio Bagnoli declare no other financial or non-financial relationships and activities. Reinaldo Espindola, Natividad Benito, Isabel Mur, Sara Tedeschi, Eleonora Zamparini, Johannes G.E. Hendriks, Luisa Sorlí, Oscar Murillo, Laura Soldevila, Mathew Scarborough, Claire Scarborough, Jan Kluytmans, Mateo Carlo Ferrari, Mathias W. Pletz, Iain Mcnamara, Rosa Escudero-Sanchez, Cedric Arvieux, Cecile Batailler, Frédéric-Antoine Dauchy, Wai-Yan Liu, Jaime Lora-Tamayo, Julia Praena, Andrew Ustianowski, Jesús Rodríguez-Baño and Maria Dolores Del Toro have no conflicts to declare. At present, the affiliation of Reinaldo Espindola is Infectious Diseases and Microbiology Clinical Unit, Hospital Universitario Virgen de Valme, Seville, Spain. The study was approved by the Ethics Committees at each site. The need to obtain written informed consent was waived due to the retrospective nature of the study and anonymized data, except in the case of the French hospitals. The approval of the ethics committee of all the participating centers, with the names and references, are reflected in the table S5 of the supplementary material. The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Funding Information: 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. Publisher Copyright: © 2022, The Author(s).
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