Risk of Treatment Failure for Prosthetic Joint Infections: Retrospective Chart Review in an Outpatient Parenteral Antimicrobial Therapy Program.

IF 0.6 Q4 PHARMACOLOGY & PHARMACY

CANADIAN JOURNAL OF HOSPITAL PHARMACY Pub Date : 2023-01-01 DOI:10.4212/cjhp.3264

Deanna Flaten, Liam Berrigan, Anna Spirkina, Alfred Gin

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引用次数: 0

Abstract

Background: Prosthetic joint infections (PJIs) are a major complication of total joint replacement surgeries. Treatment includes surgical intervention with prolonged courses of IV antibiotics in outpatient parenteral antimicrobial therapy (OPAT) programs. The risk of PJI treatment failure is high and may be associated with various clinical factors.

Objectives: To determine the rate of PJI treatment failure and to identify potential risk factors for failure in patients admitted to an OPAT program.

Methods: A retrospective chart review was conducted for adult patients with PJI admitted to an OPAT program between July 1, 2013, and July 1, 2019. Treatment courses were deemed to have failed according to predetermined criteria. χ² tests and multiple linear regression were used to examine associations of comorbidities, pathogens, and antimicrobial regimens with treatment failure.

Results: In total, 100 patients associated with 137 PJI treatment courses in the OPAT program were included. Of these, 28 patients accounted for 65 of the treatment courses. Methicillin-susceptible Staphylococcus aureus was the most frequently isolated pathogen (31/137 or 22.6% of treatment courses). Patient comorbidities included body mass index of at least 30 kg/m² (58% of patients) and diabetes (41% of patients). The overall rate of treatment failure was 56.2% (77/137 treatment courses). Selected risk factors associated with treatment failure or success were diabetes (50.9% versus 29.8%; odds ratio [OR] 4.03, 95% confidence interval [CI] 1.38-12.88, p = 0.013) and depression (32.1% versus 14.9%; OR 5.02, 95% CI 1.30-22.89, p = 0.025).

Conclusions: The overall rate of PJI treatment failure in the study population was high. Patients with diabetes and depression experienced higher incidences of failure. Future investigations of comprehensive PJI management should be considered to ensure successful treatment and to minimize excessive use of health care resources.

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假体关节感染治疗失败的风险:门诊肠外抗菌药物治疗方案的回顾性图表回顾。

背景:假体关节感染是全关节置换术的主要并发症。治疗包括手术干预与延长疗程的静脉注射抗生素在门诊静脉注射抗菌药物治疗(OPAT)计划。PJI治疗失败的风险高，可能与多种临床因素有关。目的:确定PJI治疗失败率，并确定接受OPAT计划的患者失败的潜在危险因素。方法:对2013年7月1日至2019年7月1日在OPAT项目中入院的成年PJI患者进行回顾性图表回顾。根据预先确定的标准，疗程被认为是失败的。采用χ2检验和多元线性回归检验合并症、病原体和抗菌方案与治疗失败的关系。结果:共纳入100例患者，共137个PJI治疗疗程。其中，28名患者占了65个疗程。最常见的病原菌是甲氧西林敏感金黄色葡萄球菌(31/137或22.6%疗程)。患者合并症包括体重指数至少为30 kg/m2(58%的患者)和糖尿病(41%的患者)。总治疗失败率为56.2%(77/137个疗程)。与治疗失败或成功相关的风险因素有糖尿病(50.9%对29.8%;优势比[OR] 4.03, 95%可信区间[CI] 1.38 ~ 12.88, p = 0.013)和抑郁(32.1%比14.9%;OR 5.02, 95% CI 1.30-22.89, p = 0.025)。结论:研究人群中PJI治疗失败率总体较高。糖尿病和抑郁症患者失败的发生率更高。未来应考虑对PJI综合管理进行调查，以确保治疗成功，并尽量减少过度使用卫生保健资源。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CANADIAN JOURNAL OF HOSPITAL PHARMACY PHARMACOLOGY & PHARMACY-

CiteScore

1.10

自引率

0.00%

发文量

期刊介绍： The CJHP is an academic journal that focuses on how pharmacists in hospitals and other collaborative health care settings optimize safe and effective drug use for patients in Canada and throughout the world. The aim of the CJHP is to be a respected international publication serving as a major venue for dissemination of information related to patient-centred pharmacy practice in hospitals and other collaborative health care settings in Canada and throughout the world.