Characteristics of prosthetic joint infections due to Enterococcus sp. and predictors of failure: a multi-national study

Abstract

The objective of this study was to review the characteristics and outcome of prosthetic joint infections (PJI) due to Enterococcus sp. collected in 18 hospitals from six European countries. Patients with a PJI due to Enterococcus sp. diagnosed between January 1999 and July 2012 were retrospectively reviewed. Relevant information about demographics, comorbidity, clinical characteristics, microbiological data, surgical treatment and outcome was registered. Univariable and multivariable analyses were performed. A total of 203 patients met the inclusion criteria. The mean (SD) was 70.4 (13.6) years. In 59 patients the infection was diagnosed within the first 30 days (29.1%) from arthroplasty, in 44 (21.7%) between 31 and 90 days, in 54 (26.6%) between 91 days and 2 years and in 43 (21%) after 2 years. Enterococcus faecalis was isolated in 176 cases (89%). In 107 (54%) patients the infection was polymicrobial. Any comorbidity (OR 2.53, 95% CI 1.18-5.40, p 0.01), and fever (OR 2.65, 95% CI 1.23-5.69, p 0.01) were independently associated with failure. The only factor associated with remission was infections diagnosed later than 2 years (OR 0.25, 95% CI 0.09-0.71, p 0.009). In conclusion, prosthetic joint infections due to Enterococcus sp. were diagnosed within the first 2 years from arthroplasty in >70% of the patients, almost 50% had at least one comorbidity and infections were frequently polymicrobial (54%). The global failure rate was 44% and patients with comorbidities, fever, and diagnosed within the first 2 years from arthroplasty had a poor prognosis.

Prosthetic joint infection due to Enterococcus sp treated with debridement, antibiotics and retention of the implant (DAIR)

“…We agree with the authors that a standardized protocol for the management of early PJI is fundamental for achieving good results after DAIR procedures and the differences in success rate observed between our multi-national study [2] and Duijf et al [1] study (66% versus 48%) could be explained by differences in the treatment protocol. However, other factors may be involved in the discrepancy observed in success rates between both studies.…”

“…A success rate between 62 and 66% is far from the 88% success rate obtained in staphylococcal infections treated with DAIR and a combination of levofloxacin and rifampin [4]. Therefore, it is necessary to answer important clinical questions like the role of rifampin combinations [2], fosfomycin [5], linezolid [6] or new glycolipopeptides that are very active against enterococci [7]. To do this, collaborative platforms such us the European Study Group in Infections associated with Artificial Implants for promoting multi-centric studies is of paramount importance.…”

Características microbiológicas y patrones de resistencia en infecciones de prótesis articular en un hospital de referencia

“…Aunque no es un patógeno común para las infecciones ortopédicas, hay un número importante de informes que demuestran un incremento de las infecciones ortopédicas por Enterococcus spp. 23 Tornero E et al 24 realizaron un estudio multicéntrico para describir las características clínicas y microbiológicas de IPA por Enterococcus spp. en el estudio se muestra que aproximadamente el 9.3% de las IPA son causadas por estos microorganismos, siendo E. faecalis y Enterococcus faecium las especies que más se aíslan, principalmente en IPA polimicrobianas.…”

Enterococci in orthopaedic infections: Who is at risk getting infected?

“…15 The objective of the current study was to investigate whether some orthopaedic patients / types 16 of procedures are at risk for enterococcal infection. Of note, we do not address prevention [1], 17 pathophysiology [8], therapy and outcomes of orthopaedic due to enterococci, for which a 18 broader literature is available [9][10][11][12][13][14][15][16][17][18]. and 25% during the study period [19].…”

“…In the literature, enterococci might accompany other pathogens 10% [16], 18% [26], 19% [7], 141 22% [5], 32% [18], 33% [17] or 54% [29] of orthopaedic infections, but their overall incidence 142 is still less than four percents [9][10][11]17,27,28]. Moreover, monomicrobial enterococcal bone 143 and joint infections are very often hematogenous [30], stemming from a remote origin, e.g.…”