Lora-Tamayo, JaimeJaimeLora-TamayoSenneville, ÉricÉricSennevilleRibera, AlbaAlbaRiberaBernard, LouisLouisBernardDupon, MichelMichelDuponZeller, ValérieValérieZellerLi, Ho KwongHo KwongLiArvieux, CédricCédricArvieuxClauss, MartinMartinClaussUçkay, IlkerIlkerUçkayVigante, DaceDaceViganteFerry, TristanTristanFerryIribarren, José AntonioJosé AntonioIribarrenPeel, Trisha NTrisha NPeelSendi, ParhamParhamSendi0000-0002-7347-6312Miksic, Nina GorišekNina GorišekMiksicRodríguez-Pardo, DolorsDolorsRodríguez-PardoDel Toro, María DoloresMaría DoloresDel ToroFernández-Sampedro, MartaMartaFernández-SampedroDapunt, UlrikeUlrikeDapuntHuotari, KaisaKaisaHuotariDavis, Joshua SJoshua SDavisPalomino, JuliánJuliánPalominoNeut, DanielleDanielleNeutClark, Benjamin MBenjamin MClarkGottlieb, ThomasThomasGottliebTrebše, RihardRihardTrebšeSoriano, AlexAlexSorianoBahamonde, AlbertoAlbertoBahamondeGuío, LauraLauraGuíoRico, AliciaAliciaRicoSalles, Mauro JcMauro JcSallesPais, M José GM José GPaisBenito, NatividadNatividadBenitoRiera, MelchorMelchorRieraGómez, LucíaLucíaGómezAboltins, Craig ACraig AAboltinsEsteban, JaimeJaimeEstebanHorcajada, Juan PabloJuan PabloHorcajadaO'Connell, KarinaKarinaO'ConnellFerrari, MatteoMatteoFerrariSkaliczki, GáborGáborSkaliczkiSan Juan, RafaelRafaelSan JuanCobo, JavierJavierCoboSánchez-Somolinos, MarMarSánchez-SomolinosRamos, AntonioAntonioRamosGiannitsioti, EfthymiaEfthymiaGiannitsiotiJover-Sáenz, AlfredoAlfredoJover-SáenzBaraia-Etxaburu, Josu MirenaJosu MirenaBaraia-EtxaburuBarbero, José MaríaJosé MaríaBarberoChoong, Peter F MPeter F MChoongAsseray, NathalieNathalieAsserayAnsart, SéverineSéverineAnsartLe Moal, GwenäelGwenäelLe MoalZimmerli, WernerWernerZimmerliAriza, JavierJavierAriza2024-10-252024-10-252017-06-15https://boris-portal.unibe.ch/handle/20.500.12422/152366Background Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success. Methods Retrospective, observational, multicenter, international study performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy. Results Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was S.agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: failure occurred in 187 (42.1%, 95% confidence interval: 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34). Conclusions this is the largest series of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed, and maybe also a potential benefit from adding rifampin.enDAIR biofilm bone and joint infection rifampin600 - Technology::610 - Medicine & health500 - Science::570 - Life sciences; biologyarticle10.7892/boris.992642836929610.1093/cid/cix227