Outcome of Patients With Streptococcal Prosthetic Joint Infections With Special Reference to Rifampicin Combinations

BMC Infect Dis. 2016 Oct 13;16(1):568. doi: 10.1186/s12879-016-1889-0.

Abstract

Background: Outcome of patients with streptococcal prosthetic joint infections (PJIs) is not well known.

Methods: We performed a retrospective multicenter cohort study that involved patients with total hip/knee prosthetic joint (THP/TKP) infections due to Streptococcus spp. from 2001 through 2009.

Results: Ninety-five streptococcal PJI episodes (50 THP and 45 TKP) in 87 patients of mean age 69.1 ± 13.7 years met the inclusion criteria. In all, 55 out of 95 cases (57.9 %) were treated with debridement and retention of the infected implants with antibiotic therapy (DAIR). Rifampicin-combinations, including with levofloxacin, were used in 52 (54.7 %) and 28 (29.5 %) cases, respectively. After a mean follow-up period of 895 days (IQR: 395-1649), the remission rate was 70.5 % (67/95). Patients with PJIs due to S. agalactiae failed in the same proportion as in the other patients (10/37 (27.1 %) versus 19/58 (32.7 %); p = .55). In the univariate analysis, antibiotic monotherapy, DAIR, antibiotic treatments other than rifampicin-combinations, and TKP were all associated with a worse outcome. The only independent variable significantly associated with the patients' outcomes was the location of the prosthesis (i.e., hip versus knee) (OR = 0.19; 95 % CI 0.04-0.93; p value 0.04).

Conclusions: The prognosis of streptococcal PJIs may not be as good as previously reported, especially for patients with an infected total knee arthroplasty. Rifampicin combinations, especially with levofloxacin, appear to be suitable antibiotic regimens for these patients.

Keywords: Outcome; Prosthetic joint infection; Rifampicin; Risk factors; Streptococcus spp.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage*
  • Arthritis / drug therapy
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Drug Therapy, Combination
  • Female
  • Hip Prosthesis / adverse effects
  • Hip Prosthesis / microbiology
  • Humans
  • Knee Joint / microbiology
  • Knee Joint / surgery
  • Knee Prosthesis / adverse effects
  • Knee Prosthesis / microbiology
  • Levofloxacin / administration & dosage
  • Male
  • Middle Aged
  • Prosthesis-Related Infections / diagnosis
  • Prosthesis-Related Infections / drug therapy*
  • Retrospective Studies
  • Rifampin / administration & dosage*
  • Streptococcal Infections / drug therapy*
  • Streptococcal Infections / etiology
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Levofloxacin
  • Rifampin