针对革兰氏阴性假体关节感染的抗菌方案:一项前瞻性多中心研究。

IF 4.1 2区 医学 Q2 MICROBIOLOGY
Antimicrobial Agents and Chemotherapy Pub Date : 2024-12-05 Epub Date: 2024-11-13 DOI:10.1128/aac.01232-24
Jaap L J Hanssen, Robert J P van der Wal, Rachid Mahdad, Stefan Keizer, Nathalie M Delfos, Joris C T van der Lugt, Karin Ellen Veldkamp, Peter A Nolte, Masja Leendertse, Luc B S Gelinck, Femke P N Mollema, Emile F Schippers, Hanke G Wattel-Louis, Rob G H H Nelissen, Henk Scheper, Mark G J de Boer
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引用次数: 0

摘要

氟喹诺酮类药物(FQs)被认为是治疗革兰氏阴性假体关节感染(GN-PJI)最有效的抗菌药物。由于氟喹诺酮类药物耐药性和副作用不断增加,因此需要替代药物。我们旨在比较清创、抗生素和植入物保留(DAIR)或一期翻修手术(1SR)治疗 GN-PJI 的不同靶向抗菌策略,并回顾 GN-PJI 口服治疗方案的文献。在这项以登记为基础的前瞻性多中心研究中,纳入了 2015 年至 2020 年期间所有由革兰阴性微生物(包括革兰阳性微生物混合感染)引起的 PJI 患者,这些患者均接受了 DAIR 或 1SR 治疗。最少随访 1 年。患者接受了口服 FQ、口服复方新诺明或静脉注射或口服 β-内酰胺类药物的靶向治疗。采用卡普兰-梅耶模型和考克斯比例危险模型进行生存分析,以确定与治疗失败可能相关的因素。74名患者接受了FQ(47人,64%)、复方新诺明(13人,18%)或β-内酰胺(14人,18%)治疗。手术策略包括 DAIR(72 例)或 1SR(2 例)。随访中位数为 449 天(四分位数间距为 89-738 天)。FQ组(72%)和复方新诺明组(92%)的无失败生存率没有差异(对数秩,P = 0.13)。在排除 FQ 组的所有假性 PJI 后,这一结果没有变化。复方新诺明是针对 GN-PJI 患者的一种潜在有效的靶向抗菌疗法。需要进行随机对照试验来证实本研究的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Targeted antimicrobial regimens for Gram-negative prosthetic joint infections: a prospective multicenter study.

Fluoroquinolones (FQs) are considered the most effective antimicrobial treatment for Gram-negative prosthetic joint infection (GN-PJI). Alternatives are needed due to increasing FQ resistance and side effects. We aimed to compare different targeted antimicrobial strategies for GN-PJI managed by debridement, antibiotics, and implant retention (DAIR) or one-stage revision surgery (1SR) and to review the literature of oral treatment options for GN-PJI. In this prospective, multicenter, registry-based study, all consecutive patients with a PJI caused by a Gram-negative microorganism (including mixed infections with Gram-positive microorganisms), managed with DAIR or 1SR from 2015 to 2020, were included. Minimum follow-up was 1 year. Patients underwent targeted therapy with oral FQ, oral cotrimoxazole, or intravenous or oral β-lactams. Survival analysis was performed with use of Kaplan-Meier and Cox proportional hazards models to identify factors potentially associated with treatment failure. Seventy-four patients who received either FQ (n = 47, 64%), cotrimoxazole (n = 13, 18%), or β-lactams (n = 14, 18%) were included. Surgical strategy consisted of DAIR (n = 72) or 1SR (n = 2). Median follow-up was 449 days (interquartile range 89-738 days). Failure free survival did not differ between the FQ (72%) and cotrimoxazole (92%) groups (log rank, P = 0.13). This outcome did not change when excluding all pseudomonal PJI in the FQ group. Cotrimoxazole is a potential effective targeted antimicrobial therapy for patients with GN-PJI. A randomized controlled trial is needed to confirm the findings of this study.

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来源期刊
CiteScore
10.00
自引率
8.20%
发文量
762
审稿时长
3 months
期刊介绍: Antimicrobial Agents and Chemotherapy (AAC) features interdisciplinary studies that build our understanding of the underlying mechanisms and therapeutic applications of antimicrobial and antiparasitic agents and chemotherapy.
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