RT Journal Article
T1 The Not-So-Good Prognosis of Streptococcal Periprosthetic Joint Infection Managed by Implant Retention: The Results of a Large Multicenter Study.
A1 Lora-Tamayo, Jaime
A1 Senneville, Éric
A1 Ribera, Alba
A1 Bernard, Louis
A1 Dupon, Michel
A1 Zeller, Valérie
A1 Li, Ho Kwong
A1 Arvieux, Cédric
A1 Clauss, Martin
A1 Uçkay, Ilker
A1 Vigante, Dace
A1 Ferry, Tristan
A1 Iribarren, José Antonio
A1 Peel, Trisha N
A1 Sendi, Parham
A1 Miksic, Nina Gorišek
A1 Rodríguez-Pardo, Dolors
A1 Del Toro, María Dolores
A1 Fernández-Sampedro, Marta
A1 Dapunt, Ulrike
A1 Huotari, Kaisa
A1 Davis, Joshua S
A1 Palomino, Julián
A1 Neut, Danielle
A1 Clark, Benjamin M
A1 Gottlieb, Thomas
A1 Trebše, Rihard
A1 Soriano, Alex
A1 Bahamonde, Alberto
A1 Guío, Laura
A1 Rico, Alicia
A1 Salles, Mauro J C
A1 Pais, M José G
A1 Benito, Natividad
A1 Riera, Melchor
A1 Gómez, Lucía
A1 Aboltins, Craig A
A1 Esteban, Jaime
A1 Horcajada, Juan Pablo
A1 O'Connell, Karina
A1 Ferrari, Matteo
A1 Skaliczki, Gábor
A1 Juan, Rafael San
A1 Cobo, Javier
A1 Sánchez-Somolinos, Mar
A1 Ramos, Antonio
A1 Giannitsioti, Efthymia
A1 Jover-Sáenz, Alfredo
A1 Baraia-Etxaburu, Josu Mirena
A1 Barbero, José María
A1 Choong, Peter F M
A1 Asseray, Nathalie
A1 Ansart, Séverine
A1 Moal, Gwenäel Le
A1 Zimmerli, Werner
A1 Ariza, Javier
A1 Group of Investigators for Streptococcal Prosthetic Joint Infection, 
K1 DAIR
K1 biofilm
K1 bone and joint infection
K1 rifampin.
AB 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.
YR 2017
FD 2017
LK http://hdl.handle.net/10668/11040
UL http://hdl.handle.net/10668/11040
LA en
DS RISalud
RD Apr 11, 2025