Successive new-pathogen prosthetic joint reinfections: Observational cohort study on 61 patients |
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| Institution: | 1. Service de Rhumatologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France;2. Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France;3. Service de Médecine Interne, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France;4. Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France;5. Laboratoire des Centres de Santé et Hôpitaux Île de France, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France;1. Department of Rheumatology, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France;2. EA 4267 “PEPITE”, UFR Santé, Franche-Comté University, 19, rue Ambroise Paré, bâtiment S, 25030 Besançon cedex, France;3. EA 4266 « EPILAB », UFR Santé, Franche-Comté University, 19, rue Ambroise Paré, bâtiment S, 25030 Besançon cedex, France;1. Department of infectious diseases, Avicenne Hospital, Bobigny, France;2. Department of rheumatology, Avicenne Hospital, Bobigny, France;3. Department of microbiology, Avicenne Hospital, Bobigny, France;1. Department of Rheumatology, St James’ Hospital, James’ Street, Dublin 8, Ireland;2. School of Medicine, Trinity College, Dublin, Ireland;3. Department of Rheumatology, St Vincent''s Hospital, Dublin, Ireland;1. Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, 563000 Zunyi, China;2. Department of Endocrinology, Affiliated Hospital of Zunyi Medical University, 563000 Zunyi, China;1. Center for Musculoskeletal Surgery, Charité–University Medicine Berlin, Berlin, Germany;2. Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany;3. Institute of Pathology, Ludwig Maximilian University of Munich, Munich, Germany;1. Caen Normandie University Hospital, Rheumatology Department, UMR-S 1075–Mobilités: vieillissement, pathologie, santé–COMETE, Caen, France;2. Purpan Hospital, Rheumatology Department, and University Toulouse III–Paul Sabatier, Toulouse, France;3. Sorbonne Université, Saint-Antoine Hospital, AP–HP, Rheumatology Department, DMU 3ID, Paris, France;4. La Cavale Blanche University Hospital, Rheumatology Department, Brest, France;5. Argenteuil Hospital, physiotherapist, Health executive, Argenteuil, France;6. Carenity, Online Patient Community, 1, rue de Stockholm, Paris, France;7. Sanofi Genzyme, 82 avenue Raspail, 94250, Gentilly, France |
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| Abstract: | ObjectivesProsthetic joint infection (PJI) treatment failure may be due to relapsing infection (same microorganism) or new-pathogen reinfection (npPJI). The aim was to describe npPJI epidemiological, clinical and microbiological characteristics, their treatments and outcomes, and identify their risk factors.MethodsThis observational, single-center, cohort study was conducted in a French Referral Center for Bone-and-Joint Infections between September 2004 and December 2015. Patients treated for at least two successive hip or knee PJIs in the same joint with a different pathogen were identified in the prospective database. We compared each patient's first PJI and subsequent npPJI(s) to analyze the type and microbiological characteristics of npPJIs. To search for npPJI risk factors, we compared those cases to a random selection of 122 “unique-episode” PJIs treated during the study period.ResultsAmong 990 PJIs, 79 (8%) npPJIs occurring in 61 patients were included. New-pathogen prosthetic joint infections (npPJIs) developed more frequently in knee (14%) than hip prostheses (5%). Median interval from the first PJI to the npPJI was 26 months. New-pathogen prosthetic joint reinfections (npPJIs) more frequently spread hematogenously (60% vs 33%) and were predominantly caused by Staphylococcus (36%) or Streptococcus (33%) species. Multivariate analysis identified two risk factors: chronic dermatitis (odds ratio: 6.23; P < 0.05) and cardiovascular diseases (odds ratio: 2.71; P < 0.01). A curative strategy was applied to 70%: DAIR (29%), one-stage (28%), two-stage exchange arthroplasty (7%) or other strategies (7%). The others received prolonged suppressive antibiotic therapy (30%).ConclusionsNew-pathogen prosthetic joint infections (npPJIs) are complex infections requiring management by multidisciplinary teams that should be adapted to each clinical situation. |
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| Keywords: | New-pathogen prosthetic joint reinfection Hematogenous infection Prosthetic knee and hip infections Staphylococcal and streptococcal infections Skin lesions |
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