Osteosynthesis-associated infection of the lower limbs by multidrug-resistant and extensively drug-resistant Gram-negative bacteria: a multicentre cohort study

Efthymia Giannitsioti (1) , Mauro José Salles , Andreas Mavrogenis , Dolors Rodriguez-Pardo , Ibai Los-Arcos , Alba Ribera , Javier Ariza , María Dolores del Toro , Sophie Nguyen , Eric Senneville (2) , Eric Bonnet , Monica Chan , Maria Bruna Pasticci , Sabine Petersdorf , Natividad Benito , Nuala O' Connell , Antonio Blanco García , Gábor Skaliczki , Pierre Tattevin (3, 4) , Zeliha Kocak Tufan , Nikolaos Pantazis , Panayiotis Megaloikonomos , Panayiotis Papagelopoulos , Alejandro Soriano , Antonios Papadopoulos (1)

1 NKUA - National and Kapodistrian University of Athens
2 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
3 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
4 BRM - ARN régulateurs bactériens et médecine

Purpose: The purpose of this study was the clinical and therapeutic assessment of lower-limb osteosynthesis-associated infection (OAI) by multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria (GNB), which have been poorly studied to date. Methods: A prospective multicentre observational study was conducted on behalf of ESGIAI (the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Implant-Associated Infections). Factors associated with remission of the infection were evaluated by multivariate and Cox regression analysis for a 24-month follow-up period. Results: Patients ( n=57 ) had a history of trauma (87.7 %), tumour resection (7 %) and other bone lesions (5.3 %). Pathogens included Escherichia coli ( n=16 ), Pseudomonas aeruginosa ( n=14 ; XDR 50 %), Klebsiella spp. ( n=7 ), Enterobacter spp. ( n=9 ), Acinetobacter spp. ( n=5 ), Proteus mirabilis ( n=3 ), Serratia marcescens ( n=2 ) and Stenotrophomonas maltophilia ( n=1 ). The prevalence of ESBL (extended-spectrum β -lactamase), fluoroquinolone and carbapenem resistance were 71.9 %, 59.6 % and 17.5 % respectively. Most patients ( n=37 ; 64.9 %) were treated with a combination including carbapenems ( n=32 ) and colistin ( n=11 ) for a mean of 63.3 d. Implant retention with debridement occurred in early OAI (66.7 %), whereas the infected device was removed in late OAI (70.4 %) ( p=0.008 ). OAI remission was achieved in 29 cases (50.9 %). The type of surgery, antimicrobial resistance and duration of treatment did not significantly influence the outcome. Independent predictors of the failure to eradicate OAI were age >60 years (hazard ratio, HR, of 3.875; 95 % confidence interval, CI95 %, of 1.540-9.752; p=0.004 ) and multiple surgeries for OAI (HR of 2.822; CI95 % of 1.144-6.963; p=0.024 ). Conclusions: Only half of the MDR/XDR GNB OAI cases treated by antimicrobials and surgery had a successful outcome. Advanced age and multiple surgeries hampered the eradication of OAI. Optimal therapeutic options remain a challenge

Domaines: Microbiologie et Parasitologie

Efthymia Giannitsioti, Mauro José Salles, Andreas Mavrogenis, Dolors Rodriguez-Pardo, Ibai Los-Arcos, et al.. Osteosynthesis-associated infection of the lower limbs by multidrug-resistant and extensively drug-resistant Gram-negative bacteria: a multicentre cohort study. Journal of Bone and Joint Infection, 2022, 7 (6), pp.279-288. ⟨10.5194/jbji-7-279-2022⟩. ⟨hal-03972431⟩