Risk factors for treatment failure in orthopedic

Risk factors for treatment failure in orthopedic - Eur J...

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ARTICLE 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 Received: 22 June 2009 /Accepted: 1 November 2009 /Published online: 28 November 2009 # Springer-Verlag 2009 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. This study has been presented at the 49th ICAAC Meeting (12 15 September 2009, San Francisco, CA, USA) as a poster presentation (Poster K-963). T. Ferry : I. Uçkay : P. Vaudaux : J. Schrenzel : S. Harbarth : D. Lew Infectious Diseases Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland T. Ferry Infectious and Tropical Diseases Unit, Croix-Rousse Hospital, Hospices Civils de Lyon, France T. Ferry : F. Laurent : F. Vandenesch : J. Etienne INSERM U851, Lyon, France T. Ferry : F. Laurent : F. Vandenesch : J. Etienne Université Claude Bernard, Lyon 1, France I. Uçkay : P. Hoffmeyer Orthopaedic Surgery Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland P. François : J. Schrenzel Genomic Research Laboratory, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland J. Schrenzel Central Laboratory of Bacteriology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland S. Harbarth Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland L. Bernard Infectious Diseases Unit, Bretonneau University Hospital, CHRU of Tours, Tours, France T. Ferry ( * ) Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, 93 Grande rue de la Croix-Rousse, 69004 Lyon, France e-mail: tristan.ferry@univ-lyon1.fr Eur J Clin Microbiol Infect Dis (2010) 29:171 180 DOI 10.1007/s10096-009-0837-y
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Microbiological factors such as infection with the predom- inant 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
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Risk factors for treatment failure in orthopedic - Eur J...

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