Abstract
Aim
Propionibacterium acnes (PA) is an important cause of shoulder prosthetic joint infections (SPJIs) for which the optimal treatment has not yet been determined. Rifampicin and Levofloxacin both showed not benefit in recent experimental models of PA-SPJIs. We describe herein the experience of five different medical French centers in order to assess factors associated with patient's outcome with special emphasize on antibiotic regimens.
Method
A multicentric retrospective study was performed, on consecutive patients with PA – related SPJIs diagnosed on the basis of at least 2 or more positive cultures of either per-operative or joint aspiration and clinical history compatible with a PJI according to the current guidelines. All patients had surgical management, followed by systemic antibiotic therapy. Remission was defined as an asymptomatic patient with functioning prosthesis at the last contact.
Results
Fifty-nine patients of mean age 66.2 ± 10.5 years were included. Most patients were at least ASA 2 (66%), 8 (14%) diabetes mellitus, 3 (5%) had neoplasia. Fourteen patients (24%) had acute, 34 (58%) subacute, and 11 late infections (19%). The mean delay from symptoms of infection to surgery was 89 ± 141 days (1–660). Surgical management consisted in implant exchange in 40 (68%) patients. Antibiotic treatment included mainly clindamycin (49%), levofloxacin (44%) and rifampin (17%), with a mean duration of 52.3 ± 31.9 days. The mean follow-up duration was 540 days ± 488 (range 12 ™ 1925). Forty-five patients were in remission (76%) in this study, 8 patients had a relapsing infection (14%), 1 a recurrence (2%) and 5 a superinfection ™ i.e, due to a different pathogen − (8%). In monovariate analysis, rifampicin/levofloxacin treatment was significantly associated with failure (p=0.038). In multivariate analysis, levofloxacin use and implants retention were significantly related to failure (p=0.02 and p=0.003, respectively).
Conclusions
Our results suggest that implant retention and levofloxacin use are two independents factors of failure in patients treated for PA – related SPJIs.
