Outpatient parenteral teicoplanin treatment in staphylococcal prosthesis infections

Abstract number: P768

Sapmaz-Karabag S., Avkan-Oguz V., Yapar N.

Objectives: Isolation of the methicillin-resistant staphylococci from orthopedic joint prosthesis infections are on increase. Patients usually require intravenous antibiotic therapy and are treated while being hospitalised for long terms. In this study we aimed to investigate the results of the outpatient parenteral teicoplanin treatment for shortening the length of stay.

Methods: Fourteen patients between the time interval January 2006 and December 2007 retrosepectively and 18 patients between January and December 2008 prospectively were included in the study. The inclusion criterion was isolation of more than one staphylococcus on the patients' microbiological culture taken during the prosthesis removal operation. Teicoplanin treatment (1×800 mg/day) was given to all cases. Inflammation parameters in the operation area and ESR, WBC, platelet counts, CRP valuations were followed up weekly.

Results: Of the patients, 20 were female (62.5%), 12 male (37.5%) and mean age was 65.72±10.87 (43–83). Twenty of the prosthesis (62.5%) were located in knee, 10 (31.3%) in hip and 2 (6.3%) in shoulder. Methicillin resistant coagulase negative staphylococcus (75%) was the most common strain with 24 patients and the second was methicillin resistant Staphylococcus aureus (15.6%) with 5 patients. Methicillin susceptible coagulase negative staphylococci were diagnosed in 2 (6.3%) patients. Only one patient was diagnosed to have Methicillin susceptible S. aureus (3.1%). No one had thrombocytopenia during the follow-up. Further radiological investigations were followed by surgical debridement in 8 cases that did not have a satisfying CRP decrease. Twenty three patients (71.9%) both clinically and laboratory responded the treatment, and new joint prostheses were placed. Five patients (15.6%) underwent surgical debridement. In 3 patients (9.4%) the treatment agent (teicoplanin) was changed and surgical debridement was performed. In one patient (3.1%) the treatment agent was changed because of the isolation a pathogen other than staphylococci. Performing surgical debridement and teicoplanin treatment succeeded in 87.5% of the cases, without performing surgical debridement the percentage of the treatment success rate was 71.9%.

Conclusion: As we did not observe any side effects and the success of treatment is high; the outpatient parenteral teicoplanin treatment can be an appropriate choice for the joint prosthesis infections.