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Article Dans Une Revue European Journal of Clinical Microbiology and Infectious Diseases Année : 2017

Prolonged suppressive antibiotic therapy for prosthetic joint infection in the elderly: a national multicentre cohort study

1 Geneva University Hospitals - HUG [Switzerland]
2 StaPath - Pathogénie des Staphylocoques – Staphylococcal Pathogenesis
3 Service de Maladies Infectieuses et Tropicales [Hôpital de la Croix-Rousse - HCL]
4 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
5 CH Béziers
6 Centre Hospitalier Métropole Savoie [Chambéry]
7 Centre Hospitalier Alès-Cévennes
8 CHU - BREST - Hôpital de la Cavale Blanche - CHRU Brest
9 Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]
10 Centre Hospitalier Henri Duffaut (Avignon)
11 CH Belfort-Montbéliard
12 Hôpital Pellegrin
13 Hôpital de Brive
14 Centre Hospitalier Chalon-sur-Saône William Morey
15 Hôpital pasteur [Colmar]
16 CHAL - Centre Hospitalier Alpes Léman
17 CHU Dijon
18 Centre Hospitalier [Douai, Nord]
19 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
20 CHV - Centre Hospitalier de Versailles André Mignot
21 AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)
22 CHU Limoges
23 CHU Nantes - Centre Hospitalier Universitaire de Nantes
24 Hôpital de la Croix-Saint-Simon
25 CHU Pitié-Salpêtrière [AP-HP]
26 Hôpital Sainte Perine [AP-HP]
27 Centre Hospitalier Saint Jean de Perpignan
28 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
29 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
30 CHIV - Centre Hospitalier Intercommunal Villeneuve-Saint-Georges
31 Hôpital Raymond Poincaré [AP-HP]
32 UVSQ - Université de Versailles Saint-Quentin-en-Yvelines
E. Oziol
  • Fonction : Auteur
T. Fraisse
O. Ruyer
  • Fonction : Auteur
F.-A. Dauchy
  • Fonction : Auteur
S. Greffe
  • Fonction : Auteur
T. Bauer
  • Fonction : Auteur
E. N. Bell
  • Fonction : Auteur
M. Buisson
  • Fonction : Auteur
A. Waldner
  • Fonction : Auteur
V. Charvet
  • Fonction : Auteur
E. Denes
  • Fonction : Auteur
E. Beretti
  • Fonction : Auteur
K. Guignery-Kadri
  • Fonction : Auteur

Résumé

During prosthetic joint infection (PJI), optimal surgical management with exchange of the device is sometimes impossible, especially in the elderly population. Thus, prolonged suppressive antibiotic therapy (PSAT) is the only option to prevent acute sepsis, but little is known about this strategy. We aimed to describe the characteristics, outcome and tolerance of PSAT in elderly patients with PJI. We performed a national cross-sectional cohort study of patients~\textgreater75~years old and treated with PSAT for PJI. We evaluated the occurrence of events, which were defined as: (i) local or systemic progression of the infection (failure), (ii) death and (iii) discontinuation or switch of PSAT. A total of 136 patients were included, with a median age of 83~years [interquartile range (IQR) 81-88]. The predominant pathogen involved was Staphylococcus (62.1%) (Staphylococcus aureus in 41.7%). A single antimicrobial drug was prescribed in 96 cases (70.6%). There were 46 (33.8%) patients with an event: 25 (18%) with an adverse drug reaction leading to definitive discontinuation or switch of PSAT, 8 (5.9%) with progression of sepsis and 13 died (9.6%). Among patients under follow-up, the survival rate without an event at 2~years was 61% [95% confidence interval (CI): 51;74]. In the multivariate Cox analysis, patients with higher World Health Organization (WHO) score had an increased risk of an event [hazard ratio (HR)~=~1.5, p~=~0.014], whereas patients treated with beta-lactams are associated with less risk of events occurring (HR~=~0.5, p~=~0.048). In our cohort, PSAT could be an effective and safe option for PJI in the elderly.
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Dates et versions

hal-01917837 , version 1 (09-11-2018)

Identifiants

Citer

V. Prendki, Tristan Ferry, P. Sergent, E. Oziol, E. Forestier, et al.. Prolonged suppressive antibiotic therapy for prosthetic joint infection in the elderly: a national multicentre cohort study. European Journal of Clinical Microbiology and Infectious Diseases, 2017, 36 (9), pp.1577-1585. ⟨10.1007/s10096-017-2971-2⟩. ⟨hal-01917837⟩
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