Enterococcal periprosthetic joint infection: clinical and microbiological findings from an 8-year retrospective cohort study
Abstract Background Treatment of enterococcal periprosthetic joint infections (PJI) is challenging due to non-standardized management strategies and lack of biofilm-active antibiotics. The optimal surgical and antimicrobial therapy are unknown. Therefore, we evaluated characteristics and outcome of...
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| Format: | Article |
| Language: | English |
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BMC
2019-12-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-019-4691-y |
| _version_ | 1819055587539812352 |
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| author | Nora Renz Rihard Trebse Doruk Akgün Carsten Perka Andrej Trampuz |
| author_facet | Nora Renz Rihard Trebse Doruk Akgün Carsten Perka Andrej Trampuz |
| author_sort | Nora Renz |
| collection | DOAJ |
| description | Abstract Background Treatment of enterococcal periprosthetic joint infections (PJI) is challenging due to non-standardized management strategies and lack of biofilm-active antibiotics. The optimal surgical and antimicrobial therapy are unknown. Therefore, we evaluated characteristics and outcome of enterococcal PJI. Methods Consecutive patients with enterococcal PJI from two specialized orthopedic institutions were retrospectively analyzed. Both institutions are following the same diagnostic and treatment concepts. The probability of relapse-free survival was estimated using Kaplan-Meier survival curves and compared by log-rank test. Treatment success was defined by absence of relapse or persistence of PJI due to enterococci or death related to enterococcal PJI. Clinical success was defined by the infection-free status, no subsequent surgical intervention for persistent or perioperative infection after re-implantation and no PJI-related death within 3 months. Results Included were 75 enterococcal PJI episodes, involving 41 hip, 30 knee, 2 elbow and 2 shoulder prostheses. PJI occurred postoperatively in 61 episodes (81%), hematogenously in 13 (17%) and by contiguous spread in one. E. faecalis grew in 64 episodes, E. faecium in 10 and E. casseliflavus in one episode(s). Additional microorganism(s) were isolated in 38 patients (51%). Enterococci were susceptible to vancomycin in 73 of 75 isolates (97%), to daptomycin in all 75 isolates, and to fosfomycin in 21 of 22 isolates (96%). The outcome data was available for 66 patients (88%). The treatment success after 3 years was 83.7% (95% confidence interval [CI]; 76.1–96.7%) and the clinical success was 67.5% (95% CI; 57.3–80.8%). In 11 patients (17%), a new PJI episode caused by a different pathogen occurred. All failures occurred within 3 years after surgery. Conclusion About half of enterococcal PJI were polymicrobial infections. The treatment success was high (84%). All treatment failures occurred within the first 3 years after revision surgery. Interestingly, 17% of patients experienced a new PJI caused by another pathogen at a later stage. Trial registration The study was retrospectively registered with the public clinical trial identification NCT0253022 at https://www.clinicaltrials.gov on 15 July 2015. |
| first_indexed | 2024-12-21T13:09:53Z |
| format | Article |
| id | doaj.art-70692389a5f44509b06e93d0db47b070 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-21T13:09:53Z |
| publishDate | 2019-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-70692389a5f44509b06e93d0db47b0702022-12-21T19:02:54ZengBMCBMC Infectious Diseases1471-23342019-12-0119111010.1186/s12879-019-4691-yEnterococcal periprosthetic joint infection: clinical and microbiological findings from an 8-year retrospective cohort studyNora Renz0Rihard Trebse1Doruk Akgün2Carsten Perka3Andrej Trampuz4Center for Musculoskeletal Surgery (CMSC), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthOrthopaedic Hospital ValdoltraCenter for Musculoskeletal Surgery (CMSC), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthCenter for Musculoskeletal Surgery (CMSC), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthCenter for Musculoskeletal Surgery (CMSC), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthAbstract Background Treatment of enterococcal periprosthetic joint infections (PJI) is challenging due to non-standardized management strategies and lack of biofilm-active antibiotics. The optimal surgical and antimicrobial therapy are unknown. Therefore, we evaluated characteristics and outcome of enterococcal PJI. Methods Consecutive patients with enterococcal PJI from two specialized orthopedic institutions were retrospectively analyzed. Both institutions are following the same diagnostic and treatment concepts. The probability of relapse-free survival was estimated using Kaplan-Meier survival curves and compared by log-rank test. Treatment success was defined by absence of relapse or persistence of PJI due to enterococci or death related to enterococcal PJI. Clinical success was defined by the infection-free status, no subsequent surgical intervention for persistent or perioperative infection after re-implantation and no PJI-related death within 3 months. Results Included were 75 enterococcal PJI episodes, involving 41 hip, 30 knee, 2 elbow and 2 shoulder prostheses. PJI occurred postoperatively in 61 episodes (81%), hematogenously in 13 (17%) and by contiguous spread in one. E. faecalis grew in 64 episodes, E. faecium in 10 and E. casseliflavus in one episode(s). Additional microorganism(s) were isolated in 38 patients (51%). Enterococci were susceptible to vancomycin in 73 of 75 isolates (97%), to daptomycin in all 75 isolates, and to fosfomycin in 21 of 22 isolates (96%). The outcome data was available for 66 patients (88%). The treatment success after 3 years was 83.7% (95% confidence interval [CI]; 76.1–96.7%) and the clinical success was 67.5% (95% CI; 57.3–80.8%). In 11 patients (17%), a new PJI episode caused by a different pathogen occurred. All failures occurred within 3 years after surgery. Conclusion About half of enterococcal PJI were polymicrobial infections. The treatment success was high (84%). All treatment failures occurred within the first 3 years after revision surgery. Interestingly, 17% of patients experienced a new PJI caused by another pathogen at a later stage. Trial registration The study was retrospectively registered with the public clinical trial identification NCT0253022 at https://www.clinicaltrials.gov on 15 July 2015.https://doi.org/10.1186/s12879-019-4691-yPeriprosthetic joint infectionEnterococcus spp.OutcomeMicrobiologyBiofilm |
| spellingShingle | Nora Renz Rihard Trebse Doruk Akgün Carsten Perka Andrej Trampuz Enterococcal periprosthetic joint infection: clinical and microbiological findings from an 8-year retrospective cohort study BMC Infectious Diseases Periprosthetic joint infection Enterococcus spp. Outcome Microbiology Biofilm |
| title | Enterococcal periprosthetic joint infection: clinical and microbiological findings from an 8-year retrospective cohort study |
| title_full | Enterococcal periprosthetic joint infection: clinical and microbiological findings from an 8-year retrospective cohort study |
| title_fullStr | Enterococcal periprosthetic joint infection: clinical and microbiological findings from an 8-year retrospective cohort study |
| title_full_unstemmed | Enterococcal periprosthetic joint infection: clinical and microbiological findings from an 8-year retrospective cohort study |
| title_short | Enterococcal periprosthetic joint infection: clinical and microbiological findings from an 8-year retrospective cohort study |
| title_sort | enterococcal periprosthetic joint infection clinical and microbiological findings from an 8 year retrospective cohort study |
| topic | Periprosthetic joint infection Enterococcus spp. Outcome Microbiology Biofilm |
| url | https://doi.org/10.1186/s12879-019-4691-y |
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