Carli Alberto V, Miller Andy O, Kapadia Milan, Chiu Yu-Fen, Westrich Geoffrey H, Brause Barry D, Henry Michael W
Hospital for Special Surgery, Division of Adult Reconstruction & Joint Replacement, 535 East 70th Street, New York, NY 10065, USA.
Hospital for Special Surgery, Infectious Disease Division, 535 East 70th Street, New York, NY 10065, USA.
J Bone Jt Infect. 2020 Mar 30;5(2):82-88. doi: 10.7150/jbji.41278. eCollection 2020.
: The role of daptomycin, a potent, safe, convenient anti-staphylococcal antibiotic, in treatment of prosthetic joint infection (PJI) is unclear. We evaluated our experience with the largest cohort of patients with staphylococcal PJI managed with daptomycin. : A cohort of staphylococcal hip and knee PJI treated with daptomycin was identified by hospital records from 2009 to 2016. All cases met Musculoskeletal Infection Society International Consensus criteria for PJI. The primary endpoint was 2 year prosthesis retention. Univariate analyses and regression statistics were calculated. : 341 patients with staphylococcal PJI were analyzed. 154 two-stages (77%) and 74 DAIR procedures (52%) met criteria for treatment success at 2 years. 77 patients were treated with daptomycin, of which 34 two-stages (68%) and 15 DAIRs (56%) achieved treatment success. Pairwise and regression analysis found no association between treatment success and daptomycin use. Organism (DAIR only) and Charlson Comorbidity Index scores (DAIR and two-stage) were significantly associated with treatment outcome. Six daptomycin patients (7.8%) had adverse side effects. : Daptomycin fared no better or worse than comparable antibiotics in a retrospective cohort of staphylococcal hip and knee PJI patients, regardless of surgical strategy. : The convenient dosing, safety, and potency of daptomycin make it an attractive antibiotic for staphylococcal PJI. However, these advantages must be weighed against higher costs and rare, but serious side effects.
达托霉素是一种高效、安全、使用方便的抗葡萄球菌抗生素，其在治疗人工关节感染（PJI）中的作用尚不清楚。我们评估了使用达托霉素治疗葡萄球菌性PJI患者的最大队列的经验。：通过2009年至2016年的医院记录确定了一组接受达托霉素治疗的葡萄球菌性髋和膝PJI患者。所有病例均符合肌肉骨骼感染学会国际PJI共识标准。主要终点是2年假体保留率。计算了单因素分析和回归统计量。：对341例葡萄球菌性PJI患者进行了分析。154例两阶段手术（77%）和74例清创、抗生素抑制和植入物保留（DAIR）手术（52%）在2年时达到治疗成功标准。77例患者接受了达托霉素治疗，其中34例两阶段手术（68%）和15例DAIR手术（56%）取得了治疗成功。成对分析和回归分析发现治疗成功与使用达托霉素之间无关联。病原体（仅DAIR手术）和查尔森合并症指数评分（DAIR手术和两阶段手术）与治疗结果显著相关。6例使用达托霉素的患者（7.8%）出现了不良反应。：在一个葡萄球菌性髋和膝PJI患者的回顾性队列中，无论手术策略如何，达托霉素的效果与同类抗生素相比并无优劣之分。：达托霉素给药方便、安全且高效，使其成为治疗葡萄球菌性PJI的一种有吸引力的抗生素。然而，这些优点必须与更高的成本以及罕见但严重的副作用相权衡。
