Determinants of methicillin-susceptible Staphylococcus aureus native bone and joint infection treatment failure: a retrospective cohort study.
Details
State: Public
Version: Final published version
Serval ID
serval:BIB_C8C97E13A03B
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Determinants of methicillin-susceptible Staphylococcus aureus native bone and joint infection treatment failure: a retrospective cohort study.
Journal
Bmc Infectious Diseases
Working group(s)
Lyon BJI study group
Contributor(s)
Ader F., Biron F., Boibieux A., Bouaziz A., Braun E., Chidiac C., Daoud F., Ferry T., Karsenty J., Lippman J., Miailhes P., Perpoint T., Peyramond D., Vallat MP., Valour F., Barrey C., Breton P., Boucher F., Desmarchelier R., Fessy MH., Guyen O., Lienhart C., Lustig S., Mojallal AA., Neyret P., Trouillet F., Vaz G., Laurent F., Rasigade JP., Vandenesch F., Deshayes E., Giammarile F., Janier M., Morelec I., Gagnieu MC., Goutelle S., Tod M., Martinez M.
ISSN
1471-2334 (Electronic)
ISSN-L
1471-2334
Publication state
Published
Issued date
2014
Volume
14
Pages
443
Language
english
Notes
Publication types: Journal Article Publication Status: epublish
Abstract
BACKGROUND: Although methicillin-susceptible Staphylococcus aureus (MSSA) native bone and joint infection (BJI) constitutes the more frequent clinical entity of BJI, prognostic studies mostly focused on methicillin-resistant S. aureus prosthetic joint infection. We aimed to assess the determinants of native MSSA BJI outcomes.
METHODS: Retrospective cohort study (2001-2011) of patients admitted in a reference hospital centre for native MSSA BJI. Treatment failure determinants were assessed using Kaplan-Meier curves and binary logistic regression.
RESULTS: Sixty-six patients (42 males [63.6%]; median age 61.2 years; interquartile range [IQR] 45.9-71.9) presented an acute (n = 38; 57.6%) or chronic (n = 28; 42.4%) native MSSA arthritis (n = 15; 22.7%), osteomyelitis (n = 19; 28.8%) or spondylodiscitis (n = 32; 48.5%), considered as "difficult-to-treat" in 61 cases (92.4%). All received a prolonged (27.1 weeks; IQR, 16.9-36.1) combined antimicrobial therapy, after surgical management in 37 cases (56.1%). Sixteen treatment failures (24.2%) were observed during a median follow-up period of 63.3 weeks (IQR, 44.7-103.1), including 13 persisting infections, 1 relapse after treatment disruption, and 2 super-infections. Independent determinants of treatment failure were the existence of a sinus tract (odds ratio [OR], 5.300; 95% confidence interval [CI], 1.166-24.103) and a prolonged delay to infectious disease specialist referral (OR, 1.134; 95% CI 1.013-1.271).
CONCLUSIONS: The important treatment failure rate pinpointed the difficulty of cure encountered in complicated native MSSA BJI. An early infectious disease specialist referral is essential, especially in debilitated patients or in presence of sinus tract.
METHODS: Retrospective cohort study (2001-2011) of patients admitted in a reference hospital centre for native MSSA BJI. Treatment failure determinants were assessed using Kaplan-Meier curves and binary logistic regression.
RESULTS: Sixty-six patients (42 males [63.6%]; median age 61.2 years; interquartile range [IQR] 45.9-71.9) presented an acute (n = 38; 57.6%) or chronic (n = 28; 42.4%) native MSSA arthritis (n = 15; 22.7%), osteomyelitis (n = 19; 28.8%) or spondylodiscitis (n = 32; 48.5%), considered as "difficult-to-treat" in 61 cases (92.4%). All received a prolonged (27.1 weeks; IQR, 16.9-36.1) combined antimicrobial therapy, after surgical management in 37 cases (56.1%). Sixteen treatment failures (24.2%) were observed during a median follow-up period of 63.3 weeks (IQR, 44.7-103.1), including 13 persisting infections, 1 relapse after treatment disruption, and 2 super-infections. Independent determinants of treatment failure were the existence of a sinus tract (odds ratio [OR], 5.300; 95% confidence interval [CI], 1.166-24.103) and a prolonged delay to infectious disease specialist referral (OR, 1.134; 95% CI 1.013-1.271).
CONCLUSIONS: The important treatment failure rate pinpointed the difficulty of cure encountered in complicated native MSSA BJI. An early infectious disease specialist referral is essential, especially in debilitated patients or in presence of sinus tract.
Keywords
Adult, Aged, Anti-Bacterial Agents/therapeutic use, Anti-Infective Agents/pharmacology, Female, Humans, Inflammation, Logistic Models, Male, Methicillin/pharmacology, Methicillin Resistance/drug effects, Middle Aged, Odds Ratio, Osteomyelitis/drug therapy, Prognosis, Recurrence, Retrospective Studies, Staphylococcal Infections/drug therapy, Staphylococcus aureus/drug effects, Treatment Failure, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
09/02/2015 15:40
Last modification date
20/08/2019 16:43