Abstract
Background: P. aeruginosa implant-associated bone and joint infections (BJI) is considered to be one of the most difficult to treat BJI. The data focusing specifically on this pathogen are sparse, and it seems difficult to extrapolate the results obtained with Enterobacteriaceae.Methods: We performed a retrospective observation study of all P. aeruginosa implant-associated BJI diagnosed at our institution from 2011 to 2018. We defined failure as any type of relapse, including persistence of the same P. aeruginosa, superinfection by another organism(s) or any other cause of relapse such as the need for a subsequent surgery. Nonparametric statistical methods were used to compare the study groups and Kaplan-Meier curves and multivariate Cox analysis and were used to detect determinants associated with treatment failure.Results: A total of 90 patients (62% men, median age 60 years IQR 47–72) including 30 (33%) prosthetic-joint infections and 60 (66%) other implant-associated BJIs were studied. Most of them were acute (62%). During the prolonged follow-up, (median 20 months; IQR 9–37), 23 patients (26%) experienced treatment failure. Optimal surgical treatment (DAIR for acute forms, explantation, 1-stage or 2-stage exchange for others) was significantly associated with a higher success rate in the univariate analysis (p = 0.003). Sixty-four (71%) patients received effective initial treatment against P. aeruginosa administered and 81 of them (90%) did for at least 3 weeks: both these parameters correlated with a higher success rate. In the multivariate Cox-analysis optimal surgical treatment, IV effective treatment of at least 3 weeks and treatment with ciprofloxacin for at least 3 months proved to be independently associated to a better outcome in patients with P. aeruginosa implant-associated BJI.Conclusion: P. aeruginosa implant-associated BJI is one of the most difficult-to-treat BJI, with a strong impact on the prognosis of the surgical strategy. An effective initial IV antibiotic treatment for at least 3 weeks seems to be required, followed by oral ciprofloxacin for a total duration of 3 months.
Highlights
Implant-associated bone and joint infection (BJI) is an uncommon, but dreadful complication of arthroplasties and orthopedic trauma
The aims of the present study are to review our experience with the treatment of acute, delayed or chronic implantassociated P. aeruginosa BJI, and to analyze the impact of optimal surgical treatment, effective antimicrobial IV therapy and ciprofloxacin use on the prognosis
Among the 1,638 implant-associated BJI occurring over the 7-year study period, 90 patients (5.5%) from the beginning of 2011 to end of 2017 were infected by Pseudomonas aeruginosa according to our definition and were included
Summary
Implant-associated bone and joint infection (BJI) is an uncommon, but dreadful complication of arthroplasties and orthopedic trauma. Even if GNB cause a minor- yet, substantial- proportion of all implant-associated BJI, they draw the attention of the medical community in light of the fact that the treatment is rather complicated and they show a less optimal outcome with longer hospitalizations -and higher costs- due to their peculiar virulence, their growing resistance to antibiotics and the comorbidities of the patients they usually infect, generally immunocompromised ones [6,7,8,9]. P. aeruginosa is considered as one of the most difficult-to-treat GNB, as a result of its growing rate of multidrug-resistant strains and its ability to develop particular virulence and persistence mechanisms, such as biofilm formation and production of small colony variants [12]. The data focusing on this pathogen are sparse, and it seems difficult to extrapolate the results obtained with Enterobacteriaceae
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