Abstract
Methods: Records of 130 cases of bone or joint infection treated with teicoplanin, 10 mg/kg/day without loading dose alone or in combination therapy, at day hospital ward of Amedeo di Savoia Hospital, Turin, between 1995 and 2002 were reviewed.
Pathogens, whenever possible, were identified from blood, bone, tissue or exudate samples and antibiotic susceptibility was tested using the disk method.
Demographic details, type of infection, presence of prosthetic material, duration of treatment, concomitant and subsequent antimicrobial agents, serum creatinine, adverse events, outcome at the end of treatment, and length of follow-up were noted from patient records. Results: Eighty-eight patients (67.7%) were male and 42 (32.3%) female. Their ages ranged from 15 to 89 years, with a median of 50 years.
The most common infections were chronic osteomyelitis with or without foreign material [96 cases (73.9%)], with a median duration of 15 months (range 1–180 months): 30 with osteosynthetic material and 22 with prosthetic implants (15 patients who had received total hip replacements and 7 patients with total knee replacements). There were 44 diagnoses of chronic osteitis not associated with foreign material or prosthetic implants. Twenty-three were septic arthritis (17.6%), 11 (8.5%) spondylitis.
In 81 cases the pathogens identified from samples of blood, bone or exudate were staphylococci (61 of Staphylococcus aureus, 20 of Staphylococcus epidermidis). In 11 cases were isolated Gram-negative bacteria, such as Pseudomonas aeruginosa (6), Proteus mirabilis (3), Enterobacter cloacae (2). Where more than one species was isolated (1 case) a combination of a Enterococcus faecalis and Pseudomonas aeruginosa (a case of spondylitis) was identified.
The causative pathogen was not identified in 37 cases (28.5%). Teicoplanin was administered i.v. at a dosage of 10 mg/kg/day once a day, alone or in combination therapy with other antibiotics. Patients received teicoplanin i.v. alone in 5 cases and with 1–3 concurrent antibiotics (ceftriaxon in most cases) for a mean time of 4.5 months (R 2–12). The final assessment was that cure or improvement (clinical success) was achieved in 102 patients (78.5%); in 3 cases (2.3%) was recorded a clinical failure for persistence of infection signs but bacteriological eradication was achieved in all cases. During the follow-up, which varied from 1 to 48 months (median 8 months) twenty-one patients (16.1%) relapsed. Nine were patients with prosthetic implants. The other recurrences were recorded in cases of chronic osteomyelitis with foreign material. Four patients (3.1%) with prosthetic joint infection were given chronic suppression therapy. Eight patients showed adverse reactions, but discontinuation of teicoplanin treatment was not necessary. Conclusions: Teicoplanin has been shown to be effective as monotherapy or combination therapy for bone and joint infections.
The abstracts were prepared by editorial secretary, Mrs K. Papastefanou. Correspondence should be addressed to Professor K.N. Malizos, Department of Orthopaedic Surgery, School of Medicine, University of Thessalia, Larissa, 41222 GREECE
