Session Type: ePosters
Session Title: ePosters
Authors(s): Y. Herry (1), G. Bourgeois (2), C. Cazorla (3), O. Lesens (4), J. Karsenty (5), A. Bouaziz (6), J. Saison (7), M.E. Langlois (8), E. Mabrut (9), F. Laurent (10), T. Ferry (11), F. Valour (11)
Authors Affiliations(s): (1) Service de chirurgie orthopédique, Hôpital René Sabran, Hospices Civils de Lyon, France, (2) Service des maladies infectieuses, Centre Hospitalier Métropole Savoie, France, (3) Service des maladies infectieuses, Centre Hospitalo-Universitaire de Saint-Etienne, France, (4) Service des maladies infectieuses, Centre Hospitalo-Universitaire de Clermont-Ferrand, France, (5) Service des maladies infectieuses, Centre Hospitalier William Morey, France, (6) Service des maladies infectieuses, Centre Hospitalier Lucien Hussel, France, (7) Service des maladies infectieuses, Centre Hospitalier de Valence, France, (8) Service des maladies infectieuses, Centre Hospitalier Saint-Joseph Saint-Luc, France, (9) Service des maladies infectieuses, CRIOAc Lyon, Hospices Civils de Lyon, France, (10) Institut des agents infectieux, CNR des staphylocoques, CRIOAc Lyon, Hospices Civils de Lyon, France, (11) Service des maladies infectieuses, CRIOAc Lyon, Hospices Civils de Lyon - INSERM U1111, Université Claude Bernard Lyon 1, France
Third Party Affiliation: Research group:
- Coordinator: F. Valour
- Infectious disease specialist: F. Valour, T. Ferry, A. Becker, C. Triffault-Fillit, E. Braun, A. Conrad, F. Ader, C. Chidiac, P. Chauvelot, P. Chabert, P. Miailhes, T. Perpoint, C. Pouderoux, S. Roux (Hospices Civils de Lyon), G. Bourgeois, A. Bosch, E. Forestier (Chambéry), C. Cazorla, E. Botelho-Nevers, A. Gagneux-Brunon, MF Lutz (Saint Etienne), O. Lesens (Clermont-Ferrand), J. Karsenty, B. Martha (Chalon-sur-Saone), A. Bouaziz, L. Adelaide (Vienne), J. Saison, H. Champagne, L. Letranchant, C. Reynaud, A. Dureault (Valence), ME. Langlois, C. Pariset (SJSL Lyon)
- Orthopedic surgeons: S. Lustig, MH Fessy, A. Viste, P. Chaudier, C. Batailler, A. Schmidt, Y. Herry, S. Martres, F. Trouillet, J. Rubini, H. Vinel (Hospices Civils de Lyon), E. Montbardon (Chambéry), B. Boyer (Saint Etienne), L. Rouquette (Clermont-Ferrand), A. Demangel (Chalon-sur-Saone), M. Guyard, P. Schiele (SLSJ Lyon)
- Bacteriologists: F. Laurent, C. Dupieux-Chabert, C. Kolanda, T. Roussel-Gaillard (Hospices Civils de Lyon), G. Imbert, O. Marchan (Toulon), M. Levast (Chambéry), A. Carricaho (Saint Etienne), J. Delmas (Clermont-Ferrand), A. Ogier-Desserey, B. Podac (Chalon-sur-Saone), AL. Danquigny, C. Pralong (Vienne), J. Sartre (Valence)
- Clinical reseach assistants: E. Mabrut (Hospices Civils de Lyon), S. Spinar (Saint Etienne), E. Petrosyan (Clermont-Ferrand)
Background:
Staphylococcus lugdunensis is an emerging etiological agent of prosthetic joint infection (PJI), tending to be more invasive than other coagulase negative staphylococci (CoNS), of which management and prognosis are poorly known.
Methods:Multicentric (n=8) retrospective (2010-20) cohort study including adults (≥18-year-old) with proven S. lugdunensis PJI (i.e. clinical, biological and/or radiological criteria for PJI and ≥1 gold-standard bacteriological sample positive for S. lugdunensis). The following surgical strategies were considered as appropriate: debridement, antibiotic and implant retention (DAIR) for acute (≤4 weeks) infections, one- or two-stage exchange for chronic infections. Risk factors for treatment failure were assessed using univariate logistic regression and treatment failure-free survival curve analysis (Kaplan-Meier, log-rank test).
Results:Eighty-four patients were included (57 [67.9%] males; median age, 69.7 [IQR, 61.8-78.9] year-old) with knee (n=56; 66.7%) or hip (n=28; 33.3%) PJI, considered as chronic in 64 (76.2%) cases. Surgical management mainly consisted in DAIR (n=43; 51.2%), two- (n=24; 28.6%) or one- (n=12; 14.3%) stage exchange. Twenty-nine (34.5%) infections were polymicrobial, mostly with other CoNS (n=16). Patients received a 13.1 (IQR, 12.0-17.1) weeks course of antimicrobial therapy, with initial intravenous treatment in 79 (94.0%) patients for 3.5 (IQR, 1.9-6.7) weeks. Rifampin was used in 61 (72.6%) patients, introduced 7.5 (IQR, 2.3-20.3) days after surgery for a median duration of 78.0 (39.8-91.8) days, and at the dose of 12.9 (IQR, 11.0-15.0) mg/kg/day. During a follow-up of 100.0 (IQR, 61.8-177.9) weeks, 33 (39.3%) treatment failures were observed, including 13 (15.5%) and 10 (11.9%) infection persistence and relapse, 20 (23.8%) unplanned surgeries, 13 (15.5%) superinfections, 3 (3.6%) definite prosthetic removal, 3 (3.6%) amputations, 14 (16.7%) suppressive antimicrobial therapy and 3 (3.6%) infection-related death. Determinants of S. lugdunensis-related treatment failure (excluding superinfections) were diabetes (OR, 3.262; 95%CI, 1.075-9.898; p=0.037), cemented prosthesis (OR, 3.068; 95%CI, 1.033-9.107; p=0.043), inappropriate surgical strategy (OR, 8.925; 95%CI, 2.655-30.001; p<10-3) and rifampin-free regimen or rifampin used for less than 14 days (OR, 3.437; 95%CI, 1.203-9.819; p=0.021). In addition, exchange of mobile components during DAIR tended to be protective (OR, 0.303; 95%CI, 0.080-1.141; p=0.078).
Conclusions:Staphylococcus lugdunensis PJI are difficult-to-treat infections, with pivotal roles of an appropriate surgical management and rifampin-based regimens.
Keyword(s): Prosthetic joint infection, Staphylococcus lugdunensis, RifampinSession Type: ePosters
Session Title: ePosters
Authors(s): Y. Herry (1), G. Bourgeois (2), C. Cazorla (3), O. Lesens (4), J. Karsenty (5), A. Bouaziz (6), J. Saison (7), M.E. Langlois (8), E. Mabrut (9), F. Laurent (10), T. Ferry (11), F. Valour (11)
Authors Affiliations(s): (1) Service de chirurgie orthopédique, Hôpital René Sabran, Hospices Civils de Lyon, France, (2) Service des maladies infectieuses, Centre Hospitalier Métropole Savoie, France, (3) Service des maladies infectieuses, Centre Hospitalo-Universitaire de Saint-Etienne, France, (4) Service des maladies infectieuses, Centre Hospitalo-Universitaire de Clermont-Ferrand, France, (5) Service des maladies infectieuses, Centre Hospitalier William Morey, France, (6) Service des maladies infectieuses, Centre Hospitalier Lucien Hussel, France, (7) Service des maladies infectieuses, Centre Hospitalier de Valence, France, (8) Service des maladies infectieuses, Centre Hospitalier Saint-Joseph Saint-Luc, France, (9) Service des maladies infectieuses, CRIOAc Lyon, Hospices Civils de Lyon, France, (10) Institut des agents infectieux, CNR des staphylocoques, CRIOAc Lyon, Hospices Civils de Lyon, France, (11) Service des maladies infectieuses, CRIOAc Lyon, Hospices Civils de Lyon - INSERM U1111, Université Claude Bernard Lyon 1, France
Third Party Affiliation: Research group:
- Coordinator: F. Valour
- Infectious disease specialist: F. Valour, T. Ferry, A. Becker, C. Triffault-Fillit, E. Braun, A. Conrad, F. Ader, C. Chidiac, P. Chauvelot, P. Chabert, P. Miailhes, T. Perpoint, C. Pouderoux, S. Roux (Hospices Civils de Lyon), G. Bourgeois, A. Bosch, E. Forestier (Chambéry), C. Cazorla, E. Botelho-Nevers, A. Gagneux-Brunon, MF Lutz (Saint Etienne), O. Lesens (Clermont-Ferrand), J. Karsenty, B. Martha (Chalon-sur-Saone), A. Bouaziz, L. Adelaide (Vienne), J. Saison, H. Champagne, L. Letranchant, C. Reynaud, A. Dureault (Valence), ME. Langlois, C. Pariset (SJSL Lyon)
- Orthopedic surgeons: S. Lustig, MH Fessy, A. Viste, P. Chaudier, C. Batailler, A. Schmidt, Y. Herry, S. Martres, F. Trouillet, J. Rubini, H. Vinel (Hospices Civils de Lyon), E. Montbardon (Chambéry), B. Boyer (Saint Etienne), L. Rouquette (Clermont-Ferrand), A. Demangel (Chalon-sur-Saone), M. Guyard, P. Schiele (SLSJ Lyon)
- Bacteriologists: F. Laurent, C. Dupieux-Chabert, C. Kolanda, T. Roussel-Gaillard (Hospices Civils de Lyon), G. Imbert, O. Marchan (Toulon), M. Levast (Chambéry), A. Carricaho (Saint Etienne), J. Delmas (Clermont-Ferrand), A. Ogier-Desserey, B. Podac (Chalon-sur-Saone), AL. Danquigny, C. Pralong (Vienne), J. Sartre (Valence)
- Clinical reseach assistants: E. Mabrut (Hospices Civils de Lyon), S. Spinar (Saint Etienne), E. Petrosyan (Clermont-Ferrand)
Background:
Staphylococcus lugdunensis is an emerging etiological agent of prosthetic joint infection (PJI), tending to be more invasive than other coagulase negative staphylococci (CoNS), of which management and prognosis are poorly known.
Methods:Multicentric (n=8) retrospective (2010-20) cohort study including adults (≥18-year-old) with proven S. lugdunensis PJI (i.e. clinical, biological and/or radiological criteria for PJI and ≥1 gold-standard bacteriological sample positive for S. lugdunensis). The following surgical strategies were considered as appropriate: debridement, antibiotic and implant retention (DAIR) for acute (≤4 weeks) infections, one- or two-stage exchange for chronic infections. Risk factors for treatment failure were assessed using univariate logistic regression and treatment failure-free survival curve analysis (Kaplan-Meier, log-rank test).
Results:Eighty-four patients were included (57 [67.9%] males; median age, 69.7 [IQR, 61.8-78.9] year-old) with knee (n=56; 66.7%) or hip (n=28; 33.3%) PJI, considered as chronic in 64 (76.2%) cases. Surgical management mainly consisted in DAIR (n=43; 51.2%), two- (n=24; 28.6%) or one- (n=12; 14.3%) stage exchange. Twenty-nine (34.5%) infections were polymicrobial, mostly with other CoNS (n=16). Patients received a 13.1 (IQR, 12.0-17.1) weeks course of antimicrobial therapy, with initial intravenous treatment in 79 (94.0%) patients for 3.5 (IQR, 1.9-6.7) weeks. Rifampin was used in 61 (72.6%) patients, introduced 7.5 (IQR, 2.3-20.3) days after surgery for a median duration of 78.0 (39.8-91.8) days, and at the dose of 12.9 (IQR, 11.0-15.0) mg/kg/day. During a follow-up of 100.0 (IQR, 61.8-177.9) weeks, 33 (39.3%) treatment failures were observed, including 13 (15.5%) and 10 (11.9%) infection persistence and relapse, 20 (23.8%) unplanned surgeries, 13 (15.5%) superinfections, 3 (3.6%) definite prosthetic removal, 3 (3.6%) amputations, 14 (16.7%) suppressive antimicrobial therapy and 3 (3.6%) infection-related death. Determinants of S. lugdunensis-related treatment failure (excluding superinfections) were diabetes (OR, 3.262; 95%CI, 1.075-9.898; p=0.037), cemented prosthesis (OR, 3.068; 95%CI, 1.033-9.107; p=0.043), inappropriate surgical strategy (OR, 8.925; 95%CI, 2.655-30.001; p<10-3) and rifampin-free regimen or rifampin used for less than 14 days (OR, 3.437; 95%CI, 1.203-9.819; p=0.021). In addition, exchange of mobile components during DAIR tended to be protective (OR, 0.303; 95%CI, 0.080-1.141; p=0.078).
Conclusions:Staphylococcus lugdunensis PJI are difficult-to-treat infections, with pivotal roles of an appropriate surgical management and rifampin-based regimens.
Keyword(s): Prosthetic joint infection, Staphylococcus lugdunensis, Rifampin