223. Microbiological Epidemiology in Patients Experiencing Microbiological or Clinical Failure Following Reimplantation After a 2-stage Exchange Strategy for Hip or Knee Prosthetic Joint Infection (PJI)
Session: Poster Abstract Session: Clinical: Bone and Joint Infection
Thursday, October 5, 2017
Room: Poster Hall CD
Background:

Patients with late PJI are at risk for superinfection at the time of reimplantation. Different commercially available antibiotic-loaded cements (gentamicin, vancomycin, gentamicin+clindamycin [G+C], gentamicin+vancomycin [G+V]) could be used for the fixation of the new prosthesis and could be effective to treat or prevent superinfection. We aim to determine the microbiological epidemiology in patients experiencing failure following reimplantation to establish, based on the drug susceptibilities, which cement could be the most active.

Methods:

Prospective cohort study including all patients with a 2-stage exchange in 2013-2015. Microbiological failure was defined by positive culture at the time of reimplantation. Clinical failure was defined by patients with clinical signs of infection requiring a new surgery.

Results:

We included 117 patients (median age 70 years). Forteen patients (12%) experienced a failure: 7 patients with microbiological failure (4 CoNS, 1 P. acnes, 1 corynebacterium and 3 Candida albicans); 7 patients with a clinical relapse requiring a new surgery (3 Enterobacteriaceae, 2 P. aeruginosa, 1 streptococcus spp, 1 CoNS, 1 P. acnes, 1 E. faecalis). Considering the use of a vancomycin-loaded cement, this antibiotic was inactive on Candida (n=3) and Gram-negative isolates (n=5). Considering the use of gentamicin, this antibiotic was inactive on Candida (n=3) and 5 bacterial isolates. These five letter isolates were also not susceptible to Clindamycin. Considering the use of G+V, this combination was inactive on Candida (n=3) and only 1 bacterial isolate (a gentamicin-resistant K. pneumonia). Consequently, the vancomycin-, gentamicin- and G+C-loaded cements may effectively treat or prevent 42.9% of superinfections, only. Conversely, the G+V-loaded cement may effectively treat or prevent 71.4% of them.

Conclusion:

Considering the commercially available antibiotic-loaded: none of the Candida albicans superinfection could be locally treated, and the G+V-loaded cement could treat or prevent most bacterial superinfections.

Tristan Ferry, MD, PhD1, Hassan Serrier, MD2, Frederic Laurent, DPharm, PhD3, Eugenie Mabrut, CRA4, Michel-Henri Fessy, MD, PhD5, Christian Chidiac, MD, PhD4, Laure Huot, MD2, S├ębastien Lustig, MD, PhD6 and Florent Valour, MD, PhD4, (1)Inserm 1111, UCBL1, Hospices Civils de Lyon, Lyon, France, (2)Hospices Civils de Lyon - Cellule Innovation, Lyon, France, (3)Laboratory of Bacteriology, Regional Reference Center for Bji, Hospices Civils de Lyon, Lyon, France, (4)ID Department, Regional Reference Center for Bji, Hospices Civils de Lyon, Lyon, France, (5)Hospices Civils de Lyon - Centre Hospitalier Lyon Sud, Pierre-Benite, France, (6)Orthopaedic Surgery, Regional Reference Center for Bji, Hospices Civils de Lyon, Lyon, France

Disclosures:

T. Ferry, HERAEUS: Consultant , Speaker honorarium

H. Serrier, None

F. Laurent, None

E. Mabrut, None

M. H. Fessy, None

C. Chidiac, None

L. Huot, None

S. Lustig, Heraeus: Consultant , Consulting fee

F. Valour, None

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