High resistance rates to ciprofloxacin in Gram-negative prosthetic joint infections

ABSTRACT The aim of our study was to evaluate the outcome of acute prosthetic joint infections (PJIs) due to gram-negative bacilli (GNB) treated without implant removal. Patients with an acute PJI due to GNB diagnosed from 2000 to 2007 were prospectively registered. Demographics, comorbidity, type of implant, microbiology data, surgical treatment, antimicrobial therapy, and outcome were recorded. Classification and regression tree analysis, the Kaplan-Meier survival method, and the Cox regression model were applied. Forty-seven patients were included. The mean age was 70.7 years, and there were 15 hip prostheses and 32 knee prostheses. The median number of days from the time of arthroplasty was 20. The most frequent pathogens were members of the Enterobacteriaceae family in 41 cases and Pseudomonas spp. in 20 cases. Among the Enterobacteriaceae, 14 were resistant to ciprofloxacin, while all Pseudomonas aeruginosa isolates were susceptible to ciprofloxacin. The median durations of intravenous and oral antibiotic treatment were 14 and 64 days, respectively. A total of 35 (74.5%) patients were in remission after a median follow-up of 463 days (interquartile range, 344 to 704) days. By use of the Kaplan-Meier survival curve, a C-reactive protein (CRP) concentration of ≤15 mg/dl (P = 0.03) and receipt of a fluoroquinolone, when all GNB isolated were susceptible (P = 0.0009), were associated with a better outcome. By use of a Cox regression model, a CRP concentration of ≤15 mg/dl (odds ratio [OR], 3.57; 95% confidence interval [CI], 1.05 to 12.5; P = 0.043) and receipt of a fluoroquinolone (OR, 9.09; 95% CI, 1.96 to 50; P = 0.005) were independently associated with better outcomes. Open debridement without removal of the implant had a success rate of 74.5%, and the factors associated with good prognosis were a CRP concentration at the time of diagnosis ≤15 mg/dl and treatment with a fluoroquinolone.

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Corrigendum to “Multidrug-resistant and extensively drug-resistant Gram-negative prosthetic joint infections: Role of surgery and impact of colistin administration” [International Journal of Antimicrobial Agents 53(3) (2019) 294–301]

International Journal of Antimicrobial Agents ◽

10.1016/j.ijantimicag.2019.03.005 ◽

2019 ◽

Vol 53 (4) ◽

pp. 538-539

Author(s):

Antonios Papadopoulos ◽

Alba Ribera ◽

Andreas F. Mavrogenis ◽

Dolors Rodriguez-Pardo ◽

Eric Bonnet ◽

...

Keyword(s):

Antimicrobial Agents ◽

Multidrug Resistant ◽

Drug Resistant ◽

Gram Negative ◽

Joint Infections ◽

Extensively Drug Resistant ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

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2285. Emergence of perioperative antibiotic non-susceptible pathogens causing prosthetic joint infections in monomicrobial Gram-negative and polymicrobial infections.

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1963 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S783-S783

Author(s):

Meredith M Coyle ◽

Kathleen M Riederer ◽

Babak Hooshmand ◽

Dima Youssef ◽

Ashish Bhargava

Keyword(s):

Degenerative Joint Disease ◽

Joint Disease ◽

Gram Negative ◽

Drug Of Choice ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Perioperative Antibiotics ◽

Icd Codes ◽

Polymicrobial Infections

Abstract Background Current recommendations by Infectious diseases society of America (IDSA) endorse cefazolin for perioperative use. What is less known currently is the emergence of resistance in Gram-positive (GP) and Gram-negative (GN) prosthetic joint infections (PJIs) in the setting of perioperative use of antibiotics. Methods A retrospective multi-centric cohort was studied at three hospitals from January 2012 to December 2018. Patients with PJIs were identified using ICD codes. We reviewed electronic medical records and identified PJIs which followed primary arthroplasties. We included cases where perioperative antibiotics records were available. Results 66 infected PJIs with available preoperative records were included. 40 (61%) patients were females, and 42 (64%) were caucasians. Indications for undergoing arthroplasty were degenerative joint disease (DJD) in 52 (78%), trauma in 13 (20%) and avascular necrosis in 1 (1.5%). Sites for arthroplasty were knee in 33 (50%), hip 28 (42.5%), shoulder 4 (6%), and ankle in 1(1.5%). 43 (65%) had GP monomicrobial, 6 (9%) had GN monomicrobial and 17 (26%) had polymicrobial infections. 40 (60.5%) patients received cefazolin, 25 (38%) received vancomycin and 1 (1.5%) received ceftriaxone as perioperative prophylaxis. 7 (11%) PJIs among monomicrobial infections and 6 (35%) among polymicrobial infections had non-susceptible (NS) organisms (Figure 1 and 2). 8 (47%) polymicrobial PJIs had a mixed susceptibility profile with drug susceptible and resistant organisms. Conclusion In general, when monomicrobial GP pathogens are causative for PJI, current use of cefazolin as perioperative drug of choice is sound and we agree with the current perioperative recommendations. It should be recognized that in situations where the PJI is due to GN or is polymicrobial, resistance to perioperative antibiotics may be present at a greater rate. From this study we conclude that in cases where the pathogen is known to be GN or polymicrobial from a diagnostic aspiration, then a broader antibiotic selection may be of benefit perioperatively. Disclosures All authors: No reported disclosures.

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Prosthetic Joint Infection Trends at a Dedicated Orthopaedics Specialty Hospital

Advances in Orthopedics ◽

10.1155/2019/4629503 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Robert P. Runner ◽

Amanda Mener ◽

James R. Roberson ◽

Thomas L. Bradbury ◽

George N. Guild ◽

...

Keyword(s):

Incidence Rate ◽

Joint Infection ◽

Hospital Setting ◽

University Hospital ◽

Gram Negative ◽

Joint Infections ◽

Orthopaedic Hospital ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Specialty Hospital

Introduction. Historically, a majority of prosthetic joint infections (PJIs) grew Gram-positive bacteria. While previous studies stratified PJI risk with specific organisms by patient comorbidities, we compared infection rates and microbiologic characteristics of PJIs by hospital setting: a dedicated orthopaedic hospital versus a general hospital serving multiple surgical specialties. Methods. A retrospective review of prospectively collected data on 11,842 consecutive primary hip and knee arthroplasty patients was performed. Arthroplasty cases performed between April 2006 and August 2008 at the general university hospital serving multiple surgical specialties were compared to cases at a single orthopaedic specialty hospital from September 2008 to August 2016. Results. The general university hospital PJI incidence rate was 1.43%, with 5.3% of infections from Gram-negative species. In comparison, at the dedicated orthopaedic hospital, the overall PJI incidence rate was substantially reduced to 0.75% over the 8-year timeframe. Comparing the final two years of practice at the general university facility to the most recent two years at the dedicated orthopaedics hospital, the PJI incidence was significantly reduced (1.43% vs 0.61%). Though the overall number of infections was reduced, there was a significantly higher proportion of Gram-negative infections over the 8-year timeframe at 25.3%. Conclusion. In transitioning from a multispecialty university hospital to a dedicated orthopaedic hospital, the PJI incidence has been significantly reduced despite a greater Gram-negative proportion (25.3% versus 5.3%). These results suggest a change in the microbiologic profile of PJI when transitioning to a dedicated orthopaedic facility and that greater Gram-negative antibiotic coverage could be considered.

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Multidrug-resistant and extensively drug-resistant Gram-negative prosthetic joint infections: Role of surgery and impact of colistin administration

International Journal of Antimicrobial Agents ◽

10.1016/j.ijantimicag.2018.10.018 ◽

2019 ◽

Vol 53 (3) ◽

pp. 294-301 ◽

Cited By ~ 12

Author(s):

Antonios Papadopoulos ◽

Alba Ribera ◽

Andreas F Mavrogenis ◽

Dolors Rodriguez-Pardo ◽

Eric Bonnet ◽

...

Keyword(s):

Multidrug Resistant ◽

Drug Resistant ◽

Gram Negative ◽

Joint Infections ◽

Extensively Drug Resistant ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

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1070. In vitro Activity of PLG0206 Against Isolates Commonly Found in Periprosthetic Joint Infections (PJI)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1264 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S627-S628

Author(s):

David Huang ◽

Jonathan Steckbeck ◽

Chris Pillar ◽

Bev Murray ◽

David Huganfel ◽

...

Keyword(s):

Culture Collection ◽

Multi Drug Resistance ◽

Broth Microdilution ◽

Coagulase Negative Staphylococci ◽

Cationic Antimicrobial Peptide ◽

Gram Negative ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

Abstract Background PLG0206 is a novel engineered cationic antimicrobial peptide being evaluated for treatment of prosthetic joint infections. In this study, the activity of PLG0206 was evaluated by broth microdilution against 104 isolates of Staphylococcus epidermidis, 53 other coagulase-negative staphylococci (CoNS), 3 S. aureus, and 66 Gram-negative isolates consisting of Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii. Methods Imipenem, levofloxacin, tigecycline, linezolid, vancomycin, oxacillin, ceftazidime, colistin, and amikacin were tested as comparators. Testing was conducted in accordance with guidelines from the Clinical and Laboratory Standards Institute (CLSI; M7 and M100). Test organisms consisted of reference strains from the American Type Culture Collection, the Centers for Disease Control Antibiotic Reference Bank and clinical isolates from the Micromyx repository. The media employed for testing in the broth microdilution MIC assay for all organisms were cation-adjusted Mueller Hinton Broth and for PLG0206 only included RPMI-1640 medium supplemented with 0.002% P-80. Results Activity of PLG0206 in RPMI against CoNS, S. aureus, and resistant Gram-negative* pathogens are shown in Table. Activity of PLG0206 in RPMI against CoNS, S. aureus and resistant Gram-negative* pathogens Activity of PLG0206 in RPMI against CoNS, S. aureus and resistant Gram-negative* pathogens Conclusion PLG0206 was found to have potent antimicrobial activity when evaluated in RPMI against S. epidermidis, CoNS non-epidermidis, S. aureus, Enterobacterales, P. aeruginosa, and A. baumannii, including isolates with multi-drug resistance. Disclosures David Huang, MD, PhD, Peptilogics (Employee) Jonathan Steckbeck, PhD, Peptilogics (Employee) Chris Pillar, PhD, Micromyx (Employee) Bev Murray, BS, Micromyx (Employee) David Huganfel, BS, Micromyx (Employee) Dean Shinabanger, PhD, Micromyx (Employee)

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Gram-negative prosthetic joint infections managed according to a multidisciplinary standardized approach: risk factors for failure and outcome with and without fluoroquinolones

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkw202 ◽

2016 ◽

Vol 71 (9) ◽

pp. 2593-2597 ◽

Cited By ~ 10

Author(s):

O. Grossi ◽

N. Asseray ◽

C. Bourigault ◽

S. Corvec ◽

M. Valette ◽

...

Keyword(s):

Risk Factors ◽

Treatment Failure ◽

Failure Rate ◽

Antibiotic Administration ◽

Gram Negative ◽

Joint Infections ◽

Prosthetic Joint ◽

Additional Surgery ◽

Prosthetic Joint Infections

Abstract Objectives To describe the outcome and risk factors for treatment failure of 76 Gram-negative bacilli (GNB) prosthetic joint infections (PJIs) managed with a curative intent according to a standardized protocol derived from published guidelines. Methods We analysed data from all the cases of GNB-PJI treated surgically over an 8 year period. Treatment failure was defined as persistence or recurrence of PJI signs during follow-up, resulting in additional surgery and/or antibiotic administration or death. Results Treatment failure within the follow-up period (median = 2.6 years) was observed in 16 of 76 (21.1%) patients. The failure rate was similar whether the patients were treated with fluoroquinolones in the whole cohort (22.4% versus 16.7%, P = 0.75) and after stratification according to the surgical procedure. The low failure rate observed in patients not receiving fluoroquinolones might be explained by the standardized attitude of maintaining intravenous β-lactams throughout treatment duration (median = 90 days). In multivariate analysis, C-reactive protein level ≥175 mg/L was significantly associated with treatment failure (adjusted HR = 7.75, 95% CI = 2.66–22.59, P < 0.0001). Conclusions Management according to standardized procedures may improve the prognosis of GNB-PJI. Intravenous β-lactams, continued for 3 months, should be considered an effective alternative to fluoroquinolones.

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