The Clinical Outcome of Early Periprosthetic Joint Infections Caused by <i>Staphylococcus epidermidis</i> and Managed by Surgical Debridement in an Era of Increasing Resistance
Nada S. Shabana,
Gesine Seeber,
Alex Soriano,
Paul C. Jutte,
Silvia Westermann,
Glenn Mithoe,
Loredana Pirii,
Théke Siebers,
Bas ten Have,
Wierd Zijlstra,
Djordje Lazovic,
Marjan Wouthuyzen-Bakker
Affiliations
Nada S. Shabana
Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
Gesine Seeber
Department of Orthopaedic Surgery, Universitätsklinik für Orthopädie und Unfallchirurgie, Pius-Hospital Oldenburg, 26121 Oldenburg, Germany
Alex Soriano
Department of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, 08007 Barcelona, Spain
Paul C. Jutte
Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
Silvia Westermann
Department of Orthopaedic Surgery, Universitätsklinik für Orthopädie und Unfallchirurgie, Pius-Hospital Oldenburg, 26121 Oldenburg, Germany
Glenn Mithoe
Certe, Department of Medical Microbiology, University of Groningen, 9700 RB Groningen, The Netherlands
Loredana Pirii
Izore, Centre for Infectious Diseases Friesland, 8917 EN Leeuwarden, The Netherlands
Théke Siebers
Certe, Department of Medical Microbiology, University of Groningen, 9700 RB Groningen, The Netherlands
Bas ten Have
Department of Orthopaedic Surgery, Martini Hospital, 9728 NT Groningen, The Netherlands
Wierd Zijlstra
Department of Orthopaedic Surgery, Medical Center Leeuwarden, 8934 AD Leeuwarden, The Netherlands
Djordje Lazovic
Department of Orthopaedic Surgery, Universitätsklinik für Orthopädie und Unfallchirurgie, Pius-Hospital Oldenburg, 26121 Oldenburg, Germany
Marjan Wouthuyzen-Bakker
Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
Introduction: A risk factor for the failure of surgical debridement in patients with early periprosthetic joint infections (PJI) is the presence of multidrug-resistant microorganisms. Staphylococcus epidermidis is one of the most isolated microorganisms in PJI and is associated with emerging resistance patterns. We aimed to assess the antibiotic resistance patterns of S. epidermidis in early PJIs treated with surgical debridement and correlate them to clinical outcomes. Material and Methods: A retrospective multicentre observational study was conducted to evaluate patients with an early PJI (within 3 months after the index arthroplasty) by S. epidermidis with at least two positive intraoperative cultures. Clinical failure was defined as the need for additional surgical intervention or antibiotic suppressive therapy to control the infection. Results: A total of 157 patients were included. The highest rate of resistance was observed for methicillin in 82% and ciprofloxacin in 65% of the cases. Both were associated with a higher rate of clinical failure (41.2% vs. 12.5% (p 0.048) and 47.3% vs. 14.3% (p 0.015)), respectively. Furthermore, 70% of the cases had reduced susceptibility to vancomycin (MIC ≥ 2), which showed a trend towards a higher failure rate (39.6% vs. 19.0%, NS). Only 7% of the cases were rifampin-resistant. Only the resistance to fluoroquinolones was an independent risk factor for clinical failure in the multivariate analysis (OR 5.45, 95% CI 1.67–17.83). Conclusion: S. epidermidis PJIs show a high rate of resistance. Resistance to fluoroquinolones is associated with clinical failure. Alternative prophylactic antibiotic regimens and optimising treatment strategies are needed to improve clinical outcomes.
