Risk factors for treatment failure in orthopedic device-related methicillin-resistant Staphylococcus aureus infection

  • T. Ferry
  • I. Uçkay
  • P. Vaudaux
  • P. François
  • J. Schrenzel
  • S. Harbarth
  • F. Laurent
  • L. Bernard
  • F. Vandenesch
  • J. Etienne
  • P. Hoffmeyer
  • D. Lew
Article

Abstract

The purpose of this study was to determine the clinical and microbiological risk factors for treatment failure of methicillin-resistant Staphylococcus aureus (MRSA) orthopedic device-related infection (ODRI). A retrospective cohort study of patients with MRSA ODRI who were treated at Geneva University Hospitals between 2000 and 2008 was undertaken. Stored MRSA isolates were retrieved for genetic characterization and determination of the vancomycin minimum inhibitory concentration (MIC). Fifty-two patients were included, of whom 23 (44%) had joint arthroplasty and 29 (56%) had osteosynthesis. All 41 of the retrieved MRSA isolates were susceptible to vancomycin (MIC ≤ 2 mg/L) and 35 (85%) shared genetic characteristics of the South German clone (ST228). During a median follow-up of 391 days (range, 4–2,922 days), 18 patients (35%) experienced treatment failure involving MRSA persistence or recurrence. Microbiological factors such as infection with the predominant clone and a vancomycin MIC of 2 mg/L were not associated with treatment failure. Using a Cox proportional hazards model, implant retention (hazard ratio [HR], 4.9; 95% confidence interval [CI], 1.3–18.2; P = 0.017) and single-agent antimicrobial therapy (HR, 4.4; 95% CI, 1.2–16.3; P = 0.025) were independent predictors of treatment failure after debridement. Therapy using a combination of antimicrobials should be considered for patients with MRSA ODRI, especially when implant removal is not feasible.

Notes

Acknowledgments

This work was supported by Fondation pour la Recherche Médicale, Paris, France. We are indebted to Elzbieta Huggler, Myriam Girard, Hélène Meugnier, Michele Bes, Colette Nicollier, Christine Courtier, Christine Cardon, Céline Spinelli, and Caroline Bouveron for the isolate characterization. We thank Nathalie Vallier for assistance with the statistical analysis, Abel Ferry for technical assistance, and David Young for editorial guidance.

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • T. Ferry
    • 1
    • 2
    • 3
    • 4
    • 10
  • I. Uçkay
    • 1
    • 5
  • P. Vaudaux
    • 1
  • P. François
    • 6
  • J. Schrenzel
    • 1
    • 6
    • 7
  • S. Harbarth
    • 1
    • 8
  • F. Laurent
    • 3
    • 4
  • L. Bernard
    • 9
  • F. Vandenesch
    • 3
    • 4
  • J. Etienne
    • 3
    • 4
  • P. Hoffmeyer
    • 5
  • D. Lew
    • 1
  1. 1.Infectious Diseases UnitGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
  2. 2.Infectious and Tropical Diseases UnitCroix-Rousse HospitalHospices Civils de LyonFrance
  3. 3.INSERM U851LyonFrance
  4. 4.Université Claude BernardLyon 1France
  5. 5.Orthopaedic Surgery UnitGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
  6. 6.Genomic Research LaboratoryGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
  7. 7.Central Laboratory of BacteriologyGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
  8. 8.Infection Control ProgramGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
  9. 9.Infectious Diseases UnitBretonneau University Hospital, CHRU of ToursToursFrance
  10. 10.Service de Maladies Infectieuses et TropicalesHôpital de la Croix-RousseLyonFrance

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