Department of Infectious Diseases, Normandie University, UNICAEN, CHU de Caen Normandie, 14000, Caen, France.
Normandie Univ, UNICAEN, UNIROUEN, Inserm UMR 1311 DynaMicURe, 14000, Caen, France.
Arch Orthop Trauma Surg. 2023 Sep;143(9):5515-5526. doi: 10.1007/s00402-023-04848-4. Epub 2023 Mar 29.
The objective of this study was to evaluate the management of orthopaedic device-related infections (ODRIs) due to Enterococcus spp.
We performed a retrospective cohort study in a French tertiary university hospital. Patients with prosthetic joint- or osteosynthesis-associated infections caused by enterococci from 2013 to 2020 were included. Patients who died within 5 days after surgery; who were in palliative care; or who had osteosynthesis of the hand, foot or vertebra were excluded.
Thirty-six patients were included, with 24 in the arthroplasty group and 12 in the osteosynthesis material group. Most infections were polymicrobial (63.9%, n = 23). Debridement, antibiotics and implant retention (DAIR) was performed in 30.6% (n = 11), withdrawal of material in 16.7% (n = 6), one-stage exchange in 30.6% (n = 11) and two-stage exchange in 22.2% of cases (n = 8). The antibiotic regimen was amoxicillin in 41.6% (n = 15), rifampicin in 27.8% (n = 10), linezolid in 25% (n = 9) and/or fluoroquinolones in 30.6% (n = 11). Clinical success at 1 year was 67% (18/27). The only variable statistically associated with a decreased risk of clinical failure was a duration of antibiotic therapy of 12 weeks (p = 0.04). Patients with a lower body mass index and age tended to decrease the risk of clinical failure (p = 0.05 and 0.06 respectively).
The management of enterococcal ODRIs is complex, and ODRI patients are at high risk for relapse. In our small study, a better outcome was not demonstrated for patients with combination therapy and rifampicin use. Further studies are needed to improve the medico-surgical strategy for treating these infections.
本研究的目的是评估肠球菌引起的骨科器械相关感染（ODRI）的治疗方法。
我们进行了一项回顾性队列研究，纳入了 2013 年至 2020 年在法国一家三级大学医院就诊的因肠球菌引起的人工关节或内固定相关感染的患者。排除术后 5 天内死亡、接受姑息治疗或手部、足部或脊柱内固定的患者。
共纳入 36 例患者，其中关节置换组 24 例，内固定材料组 12 例。大多数感染为混合感染（63.9%，n=23）。30.6%（n=11）行清创、抗生素和保留植入物（DAIR）治疗，16.7%（n=6）行材料取出，30.6%（n=11）行一期置换，22.2%（n=8）行二期置换。抗生素方案为阿莫西林 41.6%（n=15）、利福平 27.8%（n=10）、利奈唑胺 25%（n=9）和/或氟喹诺酮类药物 30.6%（n=11）。1 年临床成功率为 67%（18/27）。唯一与临床失败风险降低相关的变量是抗生素治疗 12 周（p=0.04）。BMI 和年龄较低的患者临床失败风险降低（p=0.05 和 0.06）。
肠球菌 ODRI 的治疗较为复杂，ODRI 患者复发风险高。在我们的小研究中，联合治疗和利福平使用并未显示出更好的疗效。需要进一步研究以改善治疗这些感染的医-外科策略。
