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Microbiological documentation of Pseudomonas aeruginosa in bone and joint infections: analysis of 79 cases from a reference centre on a myoskeletal infections in Greece

Abstract number: P1855

Athanasia S., Giannitsioti E., Papadopoulos A., Papagelopoulos PJ., Plachouras D., Sakka V., Koratzanis E., Kouvelas K., Giamarellou H., Kanellakopoulou K.

Objectives:Pseudomonas aeruginosa is not a frequent pathogen in bone and joint (BJ) infections. In the current study, clinical characteristics and outcome of patients treated for P. aeruginosa BJ in our outpatient clinic from 1999–2007 were analysed.

Patients and Methods: All cases of BJ infections that were clinically, radiologically, laboratory and microbiologically assessed, were retrospectively analysed via an electronic data-base registry. From a total of 574 records, 79 (13.7%) were microbiologically documented (cultures from pus, intra-operative tissues, bone and foreign material samples) as BJ infections caused by P. aeruginosa. Treatment success was the clinical, radiological and microbiological resolution of the BJ infection while failure referred to all cases that did not fit this definition. Demographics, surgical operations, antimicrobial treatment outcome and infection relapses were evaluated.

Results: Male (n = 51, 64.5%) mean age 47.5 (SD+17.2) and the history of a car accident related to the BJ infection (n = 38, 48%) characterised P. aeruginosa BJ infections. These parameters (including age >65 years) did not correlate with poor outcome (p = 0.4, p = 0.5, p = 0.6 respectively). However, the presence of an infected orthopaedic device (n = 20/79) either arthroplasty or osteosynthesis, might slightly influence outcome (success 14/20 with and 27/59 without an infected device, p = 0.1). Surgical debridement predicted a successful outcome (21/36 vs 20/42, p = 0.04). The administration of high doses of ciprofloxacin (1500 mg or 2000 mg/24 h) that suggested a P. aeruginosa isolate susceptible to quinolones and offer the chance of per os treatment, is a strong predictor of good outcome (36/66 vs 5/11, p = 0.002). Neither dosing nor duration of antimicrobial treatment (mean 11, SD+ 30.3 months) seemed to influence outcome (p = 0.4 and p = 0.7 respectively). In a long-term follow-up (median 29 months, range 2–60) only 3 relapses of the infection were recruited. Overall success rates reached 50% (39/79).

Conclusions: 1. P aerugionosa BJ infections are often post-traumatic 2.Surgical debridement is the cornerstone of treatment in these infections along with appropriate antimicrobial therapy. 3 P. aeruginosa BJ infection is characterised by a high incidence (50%) of treatment failure despite adequate surgical and conservative therapy.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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