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Epidemiology and antibiotic resistance of prosthetic joint infections according to time of occurrence, a 10-year study

  • Alice Casenaz
    Affiliations
    Department of Bacteriology, Dijon Bourgogne University Hospital, BP 37013, Dijon Cedex 21070, France
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  • Lionel Piroth
    Affiliations
    Infectious Diseases Department, Dijon Bourgogne University Hospital, 14 rue Paul Gaffarel, Dijon 21079, France

    INSERM, CIC1432, Clinical Epidemiology Unit, Dijon Bourgogne University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France
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  • Ludovic Labattut
    Affiliations
    Department of Orthopaedic Surgery, Dijon University Hospital, CHU Dijon, 14 rue Paul Gaffarel, Dijon Cedex 21079, France
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  • Thibault Sixt
    Affiliations
    Infectious Diseases Department, Dijon Bourgogne University Hospital, 14 rue Paul Gaffarel, Dijon 21079, France
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  • Arnaud Magallon
    Affiliations
    Department of Bacteriology, Dijon Bourgogne University Hospital, BP 37013, Dijon Cedex 21070, France

    UMR/CNRS 6249 Chrono-Environnement, University of Bourgogne-Franche-Comté, Besançon, France
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  • Adrien Guilloteau
    Affiliations
    Methodological Support Unit, Dijon University Hospital, CHU Dijon, 14 rue Paul Gaffarel, Dijon Cedex 21079, France
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  • Catherine Neuwirth
    Affiliations
    Department of Bacteriology, Dijon Bourgogne University Hospital, BP 37013, Dijon Cedex 21070, France

    UMR/CNRS 6249 Chrono-Environnement, University of Bourgogne-Franche-Comté, Besançon, France
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  • Lucie Amoureux
    Correspondence
    Corresponding author at: Department of Bacteriology, Dijon Bourgogne University Hospital, BP 37013, Dijon Cedex 21070, France.
    Affiliations
    Department of Bacteriology, Dijon Bourgogne University Hospital, BP 37013, Dijon Cedex 21070, France

    UMR/CNRS 6249 Chrono-Environnement, University of Bourgogne-Franche-Comté, Besançon, France
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Published:August 03, 2022DOI:https://doi.org/10.1016/j.jinf.2022.07.009

      Highlights

      • Prosthetic joint infection is a devastating complication of arthroplasty.
      • The distribution of bacterial species varies according to time of occurrence.
      • Empirical antibiotic therapy should target Gram-negative bacilli in all categories.
      • Piperacillin/tazobactam-vancomycin is an appropriate empirical antibiotic therapy.
      • The empirical antibiotic therapy must be tailored to local epidemiology.

      Abstract

      Objectives

      To describe the microorganisms responsible for prosthetic joint infections (PJIs) and their antimicrobial susceptibilities, and to propose appropriate empirical antimicrobial treatments (EATs) according to time of occurrence

      Methods

      This 10-year retrospective study presents the bacterial etiology of 282 consecutive PJIs in a French hospital according to time of occurrence (adapted from Zimmerli's classification: early, <3 months; delayed, 3–12 months; late acute, >12 months with hematogenous seeding or contiguous spread; late chronic, >12 months without hematogenous seeding). The expected efficacy of various EATs was analyzed for each PJI.

      Results

      Staphylococci were the most commonly found bacteria (S. aureus (44.3%), coagulase-negative staphylococci (25.2%) with 15.2% and 49.3% methicillin resistance, respectively), followed by Gram-negative bacilli (GNB) (17.7%) and streptococci (14.9%). The distribution of species varied between categories, but antibiotics targeting GNBs were required in all categories. Imipenem-vancomycin was the most effective combination (99.3%) but should be reserved for patients with suspected resistant GNB. Cefotaxime-vancomycin was less effective in early/delayed and late PJIs (91.1% and 86.1%, respectively), due to resistant GNB and polymicrobial infections. Piperacillin/tazobactam-vancomycin appeared to be appropriate in all situations (>96% efficacy).

      Conclusion

      Proposing universal recommendations remains challenging, but a good understanding of the local epidemiology is important for optimizing EATs.

      Keywords

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