@article{3108593,
    title = "The not-so-good prognosis of streptococcal periprosthetic joint infection managed by implant retention: The results of a large multicenter study",
    author = "Lora-Tamayo, J. and Senneville, É. and Ribera, A. and Bernard, L. and Dupon, M. and Zeller, V. and Li, H.K. and Arvieux, C. and Clauss, M. and Uçkay, I. and Vigante, D. and Ferry, T. and Iribarren, J.A. and Peel, T.N. and Sendi, P. and Miksić, N.G. and Rodríguez-Pardo, D. and Del Toro, M.D. and Fernández-Sampedro, M. and Dapunt, U. and Huotari, K. and Davis, J.S. and Palomino, J. and Neut, D. and Clark, B.M. and Gottlieb, T. and Trebše, R. and Soriano, A. and Bahamonde, A. and Guío, L. and Rico, A. and Salles, M.J.C. and Pais, M.J.G. and Benito, N. and Riera, M. and Gómez, L. and Aboltins, C.A. and Esteban, J. and Horcajada, J.P. and O'connell, K. and Ferrari, M. and Skaliczki, G. and Juan, R.S. and Cobo, J. and Sánchez-Somolinos, M. and Ramos, A. and Giannitsioti, E. and Jover-Sáenz, A. and Baraia-Etxaburu, J.M. and Barbero, J.M. and Choong, P.F.M. and Asseray, N. and Ansart, S. and Moal, G.L. and Zimmerli, W. and Ariza, J.",
    journal = "Clinical Infectious Diseases",
    year = "2017",
    volume = "64",
    number = "12",
    pages = "1742-1752",
    publisher = "Oxford University Press",
    issn = "1058-4838, 1537-6591",
    doi = "10.1093/cid/cix227",
    keywords = "antibiotic agent;  beta lactam antibiotic;  rifampicin;  antiinfective agent;  beta lactam;  rifampicin, adult;  aged;  antibiotic therapy;  Article;  bacteremia;  beta hemolytic Streptococcus;  coagulase negative Staphylococcus;  combination drug therapy;  controlled study;  Corynebacterium striatum;  death;  debridement;  Enterococcus faecalis;  female;  follow up;  human;  major clinical study;  male;  monotherapy;  observational study;  periprosthetic joint infection;  priority journal;  prognosis;  retrospective study;  rheumatoid arthritis;  salvage therapy;  Staphylococcus aureus;  Streptococcus agalactiae;  Streptococcus anginosus;  Streptococcus canis;  Streptococcus constellatus;  Streptococcus dysgalactiae subsp. equisimilis;  Streptococcus equinus;  Streptococcus gordonii;  Streptococcus group G;  Streptococcus infection;  Streptococcus intermedius;  Streptococcus milleri;  Streptococcus mitis;  Streptococcus mutans;  Streptococcus oralis;  Streptococcus parasanguinis;  Streptococcus pneumoniae;  Streptococcus pyogenes;  Streptococcus salivarius;  Streptococcus sanguinis;  surgical infection;  treatment duration;  treatment failure;  biofilm;  clinical trial;  debridement;  drug effects;  infection;  infectious arthritis;  international cooperation;  isolation and purification;  microbiology;  mortality;  multicenter study;  prognosis;  Streptococcus infection, Aged;  Anti-Bacterial Agents;  Arthritis, Infectious;  beta-Lactams;  Biofilms;  Debridement;  Female;  Humans;  Internationality;  Male;  Prognosis;  Prosthesis-Related Infections;  Retrospective Studies;  Rifampin;  Salvage Therapy;  Streptococcal Infections;  Streptococcus agalactiae;  Treatment Failure",
    abstract = "Background. Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success. Methods. A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy. Results. Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: Failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34). Conclusions. This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rifampin. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America."
}