• Arch Orthop Trauma Surg · Sep 2023

    Interest in the combination of antimicrobial therapy for orthopaedic device-related infections due to Enterococcus spp.

    • Charles Maurille, Jocelyn Michon, Christophe Isnard, Goulven Rochcongar, Renaud Verdon, and Aurélie Baldolli.
    • Department of Infectious Diseases, Normandie University, UNICAEN, CHU de Caen Normandie, 14000, Caen, France. maurille-c@chu-caen.fr.
    • Arch Orthop Trauma Surg. 2023 Sep 1; 143 (9): 551555265515-5526.

    IntroductionThe objective of this study was to evaluate the management of orthopaedic device-related infections (ODRIs) due to Enterococcus spp.Materials And MethodsWe performed a retrospective cohort study in a French tertiary university hospital. Patients with prosthetic joint- or osteosynthesis-associated infections caused by enterococci from 2013 to 2020 were included. Patients who died within 5 days after surgery; who were in palliative care; or who had osteosynthesis of the hand, foot or vertebra were excluded.ResultsThirty-six patients were included, with 24 in the arthroplasty group and 12 in the osteosynthesis material group. Most infections were polymicrobial (63.9%, n = 23). Debridement, antibiotics and implant retention (DAIR) was performed in 30.6% (n = 11), withdrawal of material in 16.7% (n = 6), one-stage exchange in 30.6% (n = 11) and two-stage exchange in 22.2% of cases (n = 8). The antibiotic regimen was amoxicillin in 41.6% (n = 15), rifampicin in 27.8% (n = 10), linezolid in 25% (n = 9) and/or fluoroquinolones in 30.6% (n = 11). Clinical success at 1 year was 67% (18/27). The only variable statistically associated with a decreased risk of clinical failure was a duration of antibiotic therapy of 12 weeks (p = 0.04). Patients with a lower body mass index and age tended to decrease the risk of clinical failure (p = 0.05 and 0.06 respectively).ConclusionsThe management of enterococcal ODRIs is complex, and ODRI patients are at high risk for relapse. In our small study, a better outcome was not demonstrated for patients with combination therapy and rifampicin use. Further studies are needed to improve the medico-surgical strategy for treating these infections.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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