Non-compliance with IDSA guidelines for patients presenting with methicillin-susceptible Staphylococcus aureus prosthetic joint infection is a risk factor for treatment failure

Med Mal Infect. 2018 May;48(3):207-211. doi: 10.1016/j.medmal.2017.09.016. Epub 2017 Nov 6.


Objective: The long-term impact of treatment strategies proposed by the IDSA guidelines for patients presenting with methicillin-susceptible S. aureus (MSSA) prosthetic joint infection (PJI) is not well-known.

Patients and methods: Retrospective (2000-2010) cohort study including patients presenting with MSSA hip or knee PJI. A univariate Cox analysis was performed to determine if the non-compliance with IDSA surgical guidelines was a risk factor for treatment failure.

Results: Eighty-nine patients with a mean follow-up of 2.8 years were included. Non-compliance with IDSA surgical guidelines was associated with treatment failure (hazard ratio 2.157; 95% CI [1.022-4.7]). The American Society of Anesthesiologists score, inadequate antimicrobial therapy, and a rifampicin-based regimen did not significantly influence patient outcome.

Conclusion: Based on the IDSA guidelines, if a patient presenting with MSSA PJI is not eligible for implant retention, complete implant removal is needed to limit treatment failure.

Keywords: Guidelines; Infections de prothèses articulaires; MSSA; Prosthetic joint infections; Recommandations; SASM.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Arthritis, Infectious
  • Biofilms
  • Combined Modality Therapy
  • Conservative Treatment
  • Debridement*
  • Device Removal
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Guideline Adherence*
  • Hip Prosthesis / adverse effects*
  • Humans
  • Infusions, Intravenous
  • Knee Prosthesis / adverse effects*
  • Male
  • Methicillin / pharmacology
  • Middle Aged
  • Practice Guidelines as Topic*
  • Proportional Hazards Models
  • Prosthesis-Related Infections / drug therapy
  • Prosthesis-Related Infections / surgery
  • Prosthesis-Related Infections / therapy*
  • Recurrence
  • Retrospective Studies
  • Rifampin / administration & dosage
  • Rifampin / therapeutic use
  • Risk Factors
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / surgery
  • Staphylococcal Infections / therapy*
  • Staphylococcus aureus / drug effects
  • Treatment Failure


  • Anti-Bacterial Agents
  • Methicillin
  • Rifampin