Osteosynthesis-associated infection of the lower limbs by multidrug-resistant and extensively drug-resistant Gram-negative bacteria : a multicentre cohort study
Giannitsioti, Efthymia (University General Hospital Attikon (Haidari, Grècia))
Salles, Mauro José (Division of Infectious Diseases. Department of Internal Medicine. Escola Paulista de Medicina. Universidade Federal de São Paulo (UNIFESP))
Mavrogenis, Andreas (First Department of Orthopaedics. University General Hospital Attikon. School of Medicine. National and Kapodistrian University of Athens)
Rodriguez-Pardo, Dolors (Hospital Universitari Vall d'Hebron)
Los-Arcos, Ibai (Hospital Universitari Vall d'Hebron)
Ribera, Alba (Hospital Universitari de Bellvitge)
Ariza, Javier (Hospital Universitari de Bellvitge)
del Toro López, María Dolores (Instituto de Biomedicina de Sevilla)
Nguyen, Sophie (Infectious Diseases Department. Gustave Dron Hospital)
Senneville, Eric (Infectious Diseases Department. Gustave Dron Hospital)
Bonnet, Eric (Department of Infectious Diseases. Clinique Pasteur)
Chan, Monica (Department of Infectious Diseases. Tan Tock Seng Hospital)
Pasticci, Maria Bruna (Infectious Diseases Unit. University of Perugia)
Petersdorf, Sabine (Institute for Medical Laboratory Diagnostics. Helios University Clinic Wuppertal)
Benito, Natividad (Institut d'Investigació Biomèdica Sant Pau)
O'Connell, Nuala (Department of Clinical Microbiology. University Hospital Limerick)
Blanco García, Antonio (Fundación Jiménez Díaz. Unidad de Infección Ósea y Articular. Departamento de Medicina de Emergencia)
Skaliczki, Gábor (Department of Orthopaedics. Semmelweis University)
Tattevin, Pierre (Infectious Diseases and Intensive Care Unit. Pontchaillou University Hospital)
Kocak Tufan, Zeliha (Department of Infectious Diseases and Clinical Microbiology. Faculty of Medicine. Yildirim Beyazit University. Ankara Atatürk Education and Research Hospital)
Pantazis, Nikolaos (Department of Hygiene Epidemiology and Medical Statistics. School of Medicine. National and Kapodistrian University of Athens)
Megaloikonomos, Panayotis D. (First Department of Orthopaedics. University General Hospital Attikon. School of Medicine. National and Kapodistrian University of Athens)
Papagelopoulos, Panayotis (First Department of Orthopaedics. University General Hospital Attikon. School of Medicine. National and Kapodistrian University of Athens)
Soriano, A (Hospital Clínic i Provincial de Barcelona)
Papadopoulos, Antonios (University General Hospital Attikon (Haidari, Grècia))
Universitat Autònoma de Barcelona

Fecha:	2022
Resumen:	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 (nCombining double low line57) had a history of trauma (87. 7 %), tumour resection (7 %) and other bone lesions (5. 3 %). Pathogens included Escherichia coli (nCombining double low line16), Pseudomonas aeruginosa (nCombining double low line14; XDR 50 %), Klebsiella spp. (nCombining double low line7), Enterobacter spp. (nCombining double low line9), Acinetobacter spp. (nCombining double low line5), Proteus mirabilis (nCombining double low line3), Serratia marcescens (nCombining double low line2) and Stenotrophomonas maltophilia (nCombining double low line1). The prevalence of ESBL (extended-spectrum β-lactamase), fluoroquinolone and carbapenem resistance were 71. 9 %, 59. 6 % and 17. 5 % respectively. Most patients (nCombining double low line37; 64. 9 %) were treated with a combination including carbapenems (nCombining double low line32) and colistin (nCombining double low line11) 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 %) (pCombining double low line0. 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; pCombining double low line0. 004) and multiple surgeries for OAI (HR of 2. 822; CI95 % of 1. 144-6. 963; pCombining double low line0. 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.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Publicado en:	Journal of Bone and Joint Infection, Vol. 7 Núm. 6 (December 2022) , p. 279-288, ISSN 2206-3552

DOI: 10.5194/jbji-7-279-2022
PMID: 36644590
PMID: 15684057

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