2026-04-17T03:42:04Zhttps://recercat.cat/oai/request

oai:recercat.cat:2445/2008762026-02-26T19:09:21Zcom_2072_1057col_2072_478858col_2072_478916col_2072_478917

Osteosynthesis-associated infection of the lower limbs by multidrug-resistant and extensively drug-resistant Gram-negative bacteria: a multicentre cohort study Giannitsioti, Efthymia Salles, Mauro José Mavrogenis, Andreas Rodriguez Pardo, Dolors Los-Arcos, Ibai Ribera, Alba Ariza, Javier Toro, María Dolores del Nguyen, Sophie Senneville, Eric Bonnet, Eric Chan, Monica Pasticci, Maria Bruna Petersdorf, Sabine Benito, Natividad O' Connell, Nuala Blanco García, Antonio Skaliczki, Gábor Tattevin, Pierre Kocak Tufan, Zeliha Pantazis, Nikolaos Megaloikonomos, Panayiotis D. Papagelopoulos, Panayiotis Soriano Viladomiu, Alex Papadopoulos, Antonios ESGIAI collaborators study group Bacteris gramnegatius Drug resistance Osteosíntesi Gram-negative bacteria Resistència als medicaments Osteosynthesis 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 D 5), Proteus mirabilis ( n = 3), Serratia marcescens ( n = 2) and Stenotrophomonas maltophilia ( n = 1). The prevalence of ESBL (extended-spectrum fi -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 D 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. 2023-07-19T09:53:20Z 2023-07-19T09:53:20Z 2022-12-21 2023-06-20T15:20:54Z info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion 2206-3552 https://hdl.handle.net/2445/200876 36644590 eng Reproducció del document publicat a: https://doi.org/10.5194/jbji-7-279-2022 Journal of Bone and Joint Infection, 2022, vol. 7, num. 6, p. 279-288 https://doi.org/10.5194/jbji-7-279-2022 cc by (c) Giannitsioti, Efthymia et al., 2022 http://creativecommons.org/licenses/by/3.0/es/ info:eu-repo/semantics/openAccess 10 p. application/pdf Copernicus GmbH Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))