Conservative Treatment of Staphylococcal Prosthetic Joint Infections in Elderly Patients

• Published in: The American journal of medicine Vol. 119; no. 11; pp. 993.e7 - 993.e10
• Main Authors: Barberán, José, Aguilar, Lorenzo, Carroquino, Guillermo, Giménez, María-José, Sánchez, Beatriz, Martínez, David, Prieto, José
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2006
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Arthroplasty; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; Chi-Square Distribution; Coagulase-negative staphylococci; Debridement; Drug Administration Schedule; Female; Hip Prosthesis - adverse effects; Humans; Joint infections; Joint Prosthesis - adverse effects; Knee Prosthesis - adverse effects; Levofloxacin; Male; Methicillin Resistance; Ofloxacin - therapeutic use; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - surgery; Prosthesis-Related Infections - therapy; Rifampicin; Rifampin - therapeutic use; Staphylococcal Infections - drug therapy; Staphylococcal Infections - etiology; Staphylococcal Infections - surgery; Staphylococcal Infections - therapy; Staphylococcus aureus; Time Factors; Treatment Failure; Treatment Outcome; Levofloxacin; Joint infections; Arthroplasty; Rifampicin; Staphylococcus aureus; Coagulase-negative staphylococci
• ISSN: 0002-9343; 1555-7162; 1555-7162
• DOI: 10.1016/j.amjmed.2006.03.036

We report the outcome of debridement and prosthesis retention plus long-term levofloxacin/rifampicin treatment of prosthetic joint infections. Staphylococcal prosthesis joint infections were defined by positive culture of joint aspirate, intraoperative debridement specimens, or sinus tract discharge in the presence of clinical criteria. Patients received long-term oral levofloxacin 500 mg and rifampicin 600 mg once per day. Sixty patients (age 74.6 ± 8.4 years) were included. Coagulase-negative staphylococci were significantly more frequently isolated in the knee (78.6%; P = .00001). Of the Staphylococcus aureus isolates, 33.3% were methicillin-resistant. Time from arthroplasty to symptoms onset was higher ( P = .03) in coagulase-negative staphylococci infections. Global failure was 35% (higher for the knee) and ranged from 16.6% to 69.2% ( P = .0045) in patients with symptoms duration of less than 1 month to more than 6 months. A shorter duration of symptoms ( P = .001) and time to diagnosis ( P = .01) were found in cured patients versus patients showing failure. Among those with S. aureus infections, a higher failure rate was found with methicillin-resistance. Efficacy was higher in patients with shorter duration of symptoms, earlier diagnosis, hip infections, and methicillin susceptibility.