期刊
ANTIBIOTICS-BASEL
卷 10, 期 3, 页码 -出版社
MDPI
DOI: 10.3390/antibiotics10030340
关键词
surgical site infection; prosthetic joint infection; epidemiology; risk factors; multidrug-resistant Gram-negative bacteria; extensively drug-resistant; hematoma
资金
- Fundacao Hospitalar Sao Francisco de Assis
This study identified independent risk factors associated with multidrug-resistant GNB prosthetic joint infection, including revision arthroplasty, postoperative hematoma, previous orthopaedic infection, and early infection. Extensively drug-resistant GNB and comorbidities were independently associated with higher treatment failure rates in MDR-GNB PJI.
Gram-negative bacteria (GNB), including multidrug-resistant (MDR) pathogens, are gaining importance in the aetiology of prosthetic joint infection (PJI). This retrospective observational study identified independent risk factors (RFs) associated with MDR-GNB PJI and their influence on treatment outcomes. We assessed MDR bacteria causing hip and knee PJIs diagnosed at a Brazilian tertiary hospital from January 2014 to July 2018. RFs associated with MDR-GNB PJI were estimated by bivariate and multivariate analyses using prevalence ratios (PRs) with significance at p < 0.05. Kaplan-Meier analysis was performed to evaluate treatment outcomes. Overall, 98 PJI patients were analysed, including 56 with MDR-GNB and 42 with other bacteria. Independent RFs associated with MDR-GNB PJI were revision arthroplasty (p = 0.002), postoperative hematoma (p < 0.001), previous orthopaedic infection (p = 0.002) and early infection (p = 0.001). Extensively drug-resistant GNB (p = 0.044) and comorbidities (p = 0.044) were independently associated with MDR-GNB PJI treatment failure. In sum, MDR-GNB PJI was independently associated with previous orthopaedic surgery, postoperative local complications and pre-existing infections and was possibly related to selective pressure on bacterial skin colonisation by antibiotics prescribed for early PJI. Infections due to MDR-GNB and comorbidities were associated with higher treatment failure rates.
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