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

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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.

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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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Authors and Affiliations

  1. Infectious Diseases Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland

    T. Ferry, I. Uçkay, P. Vaudaux, J. Schrenzel, S. Harbarth & D. Lew

  2. Infectious and Tropical Diseases Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, France

    T. Ferry

  3. INSERM U851, Lyon, France

    T. Ferry, F. Laurent, F. Vandenesch & J. Etienne

  4. Université Claude Bernard, Lyon 1, France

    T. Ferry, F. Laurent, F. Vandenesch & J. Etienne

  5. Orthopaedic Surgery Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland

    I. Uçkay & P. Hoffmeyer

  6. Genomic Research Laboratory, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland

    P. François & J. Schrenzel

  7. Central Laboratory of Bacteriology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland

    J. Schrenzel

  8. Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland

    S. Harbarth

  9. Infectious Diseases Unit, Bretonneau University Hospital, CHRU of Tours, Tours, France

    L. Bernard

  10. Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, 93 Grande rue de la Croix-Rousse, 69004, Lyon, France

    T. Ferry

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  1. T. Ferry
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Correspondence to T. Ferry.

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Ferry, T., Uçkay, I., Vaudaux, P. et al. Risk factors for treatment failure in orthopedic device-related methicillin-resistant Staphylococcus aureus infection. Eur J Clin Microbiol Infect Dis 29, 171–180 (2010). https://doi.org/10.1007/s10096-009-0837-y

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  • DOI: https://doi.org/10.1007/s10096-009-0837-y

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