The Clinical Outcome of Early Periprosthetic Joint Infections Caused by <i>Staphylococcus epidermidis</i> and Managed by Surgical Debridement in an Era of Increasing Resistance
Introduction: A risk factor for the failure of surgical debridement in patients with early periprosthetic joint infections (PJI) is the presence of multidrug-resistant microorganisms. Staphylococcus epidermidis is one of the most isolated microorganisms in PJI and is associated with emerging resista...
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| Format: | Article |
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MDPI AG
2022-12-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/12/1/40 |
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| author | Nada S. Shabana Gesine Seeber Alex Soriano Paul C. Jutte Silvia Westermann Glenn Mithoe Loredana Pirii Théke Siebers Bas ten Have Wierd Zijlstra Djordje Lazovic Marjan Wouthuyzen-Bakker |
| author_facet | Nada S. Shabana Gesine Seeber Alex Soriano Paul C. Jutte Silvia Westermann Glenn Mithoe Loredana Pirii Théke Siebers Bas ten Have Wierd Zijlstra Djordje Lazovic Marjan Wouthuyzen-Bakker |
| author_sort | Nada S. Shabana |
| collection | DOAJ |
| description | Introduction: A risk factor for the failure of surgical debridement in patients with early periprosthetic joint infections (PJI) is the presence of multidrug-resistant microorganisms. Staphylococcus epidermidis is one of the most isolated microorganisms in PJI and is associated with emerging resistance patterns. We aimed to assess the antibiotic resistance patterns of <i>S. epidermidis</i> in early PJIs treated with surgical debridement and correlate them to clinical outcomes. Material and Methods: A retrospective multicentre observational study was conducted to evaluate patients with an early PJI (within 3 months after the index arthroplasty) by <i>S. epidermidis</i> with at least two positive intraoperative cultures. Clinical failure was defined as the need for additional surgical intervention or antibiotic suppressive therapy to control the infection. Results: A total of 157 patients were included. The highest rate of resistance was observed for methicillin in 82% and ciprofloxacin in 65% of the cases. Both were associated with a higher rate of clinical failure (41.2% vs. 12.5% (p 0.048) and 47.3% vs. 14.3% (p 0.015)), respectively. Furthermore, 70% of the cases had reduced susceptibility to vancomycin (MIC ≥ 2), which showed a trend towards a higher failure rate (39.6% vs. 19.0%, NS). Only 7% of the cases were rifampin-resistant. Only the resistance to fluoroquinolones was an independent risk factor for clinical failure in the multivariate analysis (OR 5.45, 95% CI 1.67–17.83). Conclusion: <i>S. epidermidis</i> PJIs show a high rate of resistance. Resistance to fluoroquinolones is associated with clinical failure. Alternative prophylactic antibiotic regimens and optimising treatment strategies are needed to improve clinical outcomes. |
| first_indexed | 2024-03-09T13:48:35Z |
| format | Article |
| id | doaj.art-e415565e20b84aa0bd52187a81f4287f |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-09T13:48:35Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-e415565e20b84aa0bd52187a81f4287f2023-11-30T20:54:52ZengMDPI AGAntibiotics2079-63822022-12-011214010.3390/antibiotics12010040The Clinical Outcome of Early Periprosthetic Joint Infections Caused by <i>Staphylococcus epidermidis</i> and Managed by Surgical Debridement in an Era of Increasing ResistanceNada S. Shabana0Gesine Seeber1Alex Soriano2Paul C. Jutte3Silvia Westermann4Glenn Mithoe5Loredana Pirii6Théke Siebers7Bas ten Have8Wierd Zijlstra9Djordje Lazovic10Marjan Wouthuyzen-Bakker11Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The NetherlandsDepartment of Orthopaedic Surgery, Universitätsklinik für Orthopädie und Unfallchirurgie, Pius-Hospital Oldenburg, 26121 Oldenburg, GermanyDepartment of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, 08007 Barcelona, SpainDepartment of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The NetherlandsDepartment of Orthopaedic Surgery, Universitätsklinik für Orthopädie und Unfallchirurgie, Pius-Hospital Oldenburg, 26121 Oldenburg, GermanyCerte, Department of Medical Microbiology, University of Groningen, 9700 RB Groningen, The NetherlandsIzore, Centre for Infectious Diseases Friesland, 8917 EN Leeuwarden, The NetherlandsCerte, Department of Medical Microbiology, University of Groningen, 9700 RB Groningen, The NetherlandsDepartment of Orthopaedic Surgery, Martini Hospital, 9728 NT Groningen, The NetherlandsDepartment of Orthopaedic Surgery, Medical Center Leeuwarden, 8934 AD Leeuwarden, The NetherlandsDepartment of Orthopaedic Surgery, Universitätsklinik für Orthopädie und Unfallchirurgie, Pius-Hospital Oldenburg, 26121 Oldenburg, GermanyDepartment of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The NetherlandsIntroduction: A risk factor for the failure of surgical debridement in patients with early periprosthetic joint infections (PJI) is the presence of multidrug-resistant microorganisms. Staphylococcus epidermidis is one of the most isolated microorganisms in PJI and is associated with emerging resistance patterns. We aimed to assess the antibiotic resistance patterns of <i>S. epidermidis</i> in early PJIs treated with surgical debridement and correlate them to clinical outcomes. Material and Methods: A retrospective multicentre observational study was conducted to evaluate patients with an early PJI (within 3 months after the index arthroplasty) by <i>S. epidermidis</i> with at least two positive intraoperative cultures. Clinical failure was defined as the need for additional surgical intervention or antibiotic suppressive therapy to control the infection. Results: A total of 157 patients were included. The highest rate of resistance was observed for methicillin in 82% and ciprofloxacin in 65% of the cases. Both were associated with a higher rate of clinical failure (41.2% vs. 12.5% (p 0.048) and 47.3% vs. 14.3% (p 0.015)), respectively. Furthermore, 70% of the cases had reduced susceptibility to vancomycin (MIC ≥ 2), which showed a trend towards a higher failure rate (39.6% vs. 19.0%, NS). Only 7% of the cases were rifampin-resistant. Only the resistance to fluoroquinolones was an independent risk factor for clinical failure in the multivariate analysis (OR 5.45, 95% CI 1.67–17.83). Conclusion: <i>S. epidermidis</i> PJIs show a high rate of resistance. Resistance to fluoroquinolones is associated with clinical failure. Alternative prophylactic antibiotic regimens and optimising treatment strategies are needed to improve clinical outcomes.https://www.mdpi.com/2079-6382/12/1/40periprosthetic joint infection<i>S. epidermidis</i>resistancesurgical debridement |
| spellingShingle | Nada S. Shabana Gesine Seeber Alex Soriano Paul C. Jutte Silvia Westermann Glenn Mithoe Loredana Pirii Théke Siebers Bas ten Have Wierd Zijlstra Djordje Lazovic Marjan Wouthuyzen-Bakker The Clinical Outcome of Early Periprosthetic Joint Infections Caused by <i>Staphylococcus epidermidis</i> and Managed by Surgical Debridement in an Era of Increasing Resistance Antibiotics periprosthetic joint infection <i>S. epidermidis</i> resistance surgical debridement |
| title | The Clinical Outcome of Early Periprosthetic Joint Infections Caused by <i>Staphylococcus epidermidis</i> and Managed by Surgical Debridement in an Era of Increasing Resistance |
| title_full | The Clinical Outcome of Early Periprosthetic Joint Infections Caused by <i>Staphylococcus epidermidis</i> and Managed by Surgical Debridement in an Era of Increasing Resistance |
| title_fullStr | The Clinical Outcome of Early Periprosthetic Joint Infections Caused by <i>Staphylococcus epidermidis</i> and Managed by Surgical Debridement in an Era of Increasing Resistance |
| title_full_unstemmed | The Clinical Outcome of Early Periprosthetic Joint Infections Caused by <i>Staphylococcus epidermidis</i> and Managed by Surgical Debridement in an Era of Increasing Resistance |
| title_short | The Clinical Outcome of Early Periprosthetic Joint Infections Caused by <i>Staphylococcus epidermidis</i> and Managed by Surgical Debridement in an Era of Increasing Resistance |
| title_sort | clinical outcome of early periprosthetic joint infections caused by i staphylococcus epidermidis i and managed by surgical debridement in an era of increasing resistance |
| topic | periprosthetic joint infection <i>S. epidermidis</i> resistance surgical debridement |
| url | https://www.mdpi.com/2079-6382/12/1/40 |
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