496. B Lactam Therapy is Superior to Vancomycin for Staphylococcus lugdunensis Prosthetic Joint Infections
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Staphylococcus lugdunensis is a coagulase negative staphylococcus that has several similarities to Staphylococcus aureus. S. lugdunensis is being increasingly recognized as a cause of prosthetic joint infection (PJI). The goal of this retrospective cohort study was to determine the demographics and outcome of total hip or knee prosthetic joint infections caused by S. lugdunensis.
Methods: The records of all patients with a total hip or knee arthroplasty infection due to S. lugdunensis seen at the Mayo Clinic in Rochester, MN between 1/1/1990 to 12/31/2007 were reviewed. Kaplan-Meier survival methods and Wilcoxin sum-rank analysis were used to determine the cumulative incidence of success and subset comparisons.
Results: There were 28 patients and 14 were female (50%). Twenty five patients (89%) presented with prosthetic knee infection, while 3 (10.7%) had hip infection. Three patients (10.7%) had diabetes mellitus and 5 (17.9%) were on chronic steroid therapy. Nine patients (32.1%) had an underlying urogenital abnormality. Fourteen patients (50%) underwent a 2 stage revision that was followed by chronic antibiotic therapy and 10 (35.7%) underwent irrigation and debridement followed by chronic antibiotic suppression. The overall cumulative incidence free of treatment failure (SD) at two years was 85 % (±7%). Parenteral B lactam therapy and vancomycin were used for a median of 38 days (range 23-42), and 39 days (range 12-60) respectively. The cumulative incidence free of treatment failure (SD) at 2 years was 92% (± 7%) and 76% (± 12%) for patients treated with parenteral B lactam and vancomycin, respectively (P=.015).
Conclusion: S. lugdunensis is being increasingly recognized as a cause of PJI. Clinical and outcome characteristics are presented.When possible, patients should be treated with a B lactam.
Neel Shah, MD, Mayo Clinic College of Graduate Medical Education, Rochester, MN and  N. B. Shah, None.