Service de chirurgie orthopédique, Hôpital René Sabran, Hospices Civils de Lyon, Hyères, France.
Université Clermont Auvergne UMR, CNRS 6023, Laboratoire Microorganismes: Génome Environnement (LMGE), Clermont-Ferrand, France; Service des maladies infectieuses et tropicales, CRIOA, 3IHP, CHU, Clermont-Ferrand, France.
J Infect. 2022 Dec;85(6):652-659. doi: 10.1016/j.jinf.2022.10.025. Epub 2022 Oct 21.
To describe Staphylococcus lugdunensis prosthetic joint infection (PJI) management and outcome.
Adults with proven S. lugdunensis PJI were included in a multicentric retrospective cohort. Determinants for failure were assessed by logistic regression and treatment failure-free survival curve analysis (Kaplan-Meier).
One hundred and eleven patients were included (median age 72.4 [IQR, 62.7-79.4] years), with a knee (n = 71, 64.0%) or hip (n = 39, 35.1%) PJI considered as chronic in 77 (69.4%) cases. Surgical management consisted in debridement, antibiotic with implant retention (DAIR; n = 60, 54.1%), two-stage (n = 28, 25.2%) or one-stage (n = 15, 13.5%) exchange. Total duration of antimicrobial therapy was 13.1 (IQR, 11.8-16.9) weeks. After a median follow-up of 99.9 (IQR, 53.9-178.1) weeks, 22 (19.8%) S. lugdunensis-related treatment failures were observed. Independent determinants for outcome were diabetes (OR, 3.741; p = 0.036), sinus tract (OR, 3.846; p = 0.032), DAIR (OR, 3.749; p = 0.039) and rifampin-based regimen (OR, 0.319; p = 0.043). Twenty-four (40.0%) of the 60 DAIR-treated patients experienced treatment failure, with hip location (OR, 3.273; p = 0.048), delay from prosthesis implantation (OR, 1.012 per month; p = 0.019), pre-surgical CRP level >115 mg/L (OR, 4.800; p = 0.039) and mobile component exchange (OR, 0.302; p = 0.069) constituting additional determinants of outcome.
Staphylococcus lugdunensis PJI are difficult-to-treat infections, with pivotal roles of an optimal surgical management.
描述路邓葡萄球菌人工关节感染（PJI）的治疗管理和结局。
本多中心回顾性队列研究纳入了确诊患有路邓葡萄球菌 PJI 的成年人。通过逻辑回归和治疗失败无生存曲线分析（Kaplan-Meier）评估失败的决定因素。
共纳入 111 例患者（中位年龄 72.4 [IQR，62.7-79.4] 岁），71 例（64.0%）为膝关节 PJI，39 例（35.1%）为髋关节 PJI，77 例（69.4%）慢性感染。手术治疗包括清创术、保留植入物的抗生素治疗（DAIR；n=60，54.1%）、二期（n=28，25.2%）或一期（n=15，13.5%）置换。抗菌治疗总持续时间为 13.1（IQR，11.8-16.9）周。中位随访 99.9（IQR，53.9-178.1）周后，22 例（19.8%）发生与路邓葡萄球菌相关的治疗失败。结局的独立决定因素为糖尿病（OR，3.741；p=0.036）、窦道（OR，3.846；p=0.032）、DAIR（OR，3.749；p=0.039）和利福平为基础的方案（OR，0.319；p=0.043）。60 例接受 DAIR 治疗的患者中有 24 例（40.0%）治疗失败，髋关节部位（OR，3.273；p=0.048）、假体植入后延迟（OR，每月增加 1.012；p=0.019）、术前 CRP 水平>115mg/L（OR，4.800；p=0.039）和活动部件置换（OR，0.302；p=0.069）是影响结局的其他决定因素。
路邓葡萄球菌 PJI 是一种难以治疗的感染，需要优化手术管理。
