Authors: Shah N.B, Osmon D.R, Fadel H. , Patel R., Steckelberg J., Mabry T., Berbari, E.F., Mayo Clinic, Rochester MN
Title: B-Lactam Therapy is Superior to Vancomycin for Staphylococcus lugdunensis Prosthetic Joint Infections
Purpose: The goal of this retrospective cohort study was to determine the demographics and outcome of total hip or knee prosthetic joint infections caused by S. lugdunensis.
Methods: The records of all patients with a total hip or knee arthroplasty infection due to S. lugdunensis seen at the Mayo Clinic in Rochester, MN between 1/1/1990 to 12/31/2007 were reviewed. Kaplan-Meier survival methods and Log-Rank analysis were used to determine the cumulative probability of success and subset comparisons
Results: There were a total of 28 patients and 14 were female (50%). Twenty five patients (89%) presented with prosthetic knee infections, while 3 (10.7%) had hip infections. Three patients (10.7%) had diabetes mellitus and 5 (17.9%) were on chronic steroid therapy. Nine patients (32.1%) had an underlying urogenital abnormality. Fourteen patients (50%) underwent a 2 stage revision that was followed by antibiotic therapy and 10 (35.7%) underwent irrigation and debridement followed by chronic suppression. The cumulative incidence free of treatment failure (SD) at two years was 85 % (±7%). Parenteral B-lactam therapy and Vancomycin were used for a median of 38 days (range 23-42), and 39 days (range 12-60) respectively. The cumulative incidence free of treatment failure (SD) at 2 years was 76% (±12%) and 92% (±7%) for patients treated with parenteral Vancomycin and B- lactam, respectively (P < .015).
Discuassion and Conclusion: Staphylococcus lugdunensis is being increasingly recognized as a cause of PJI. Clinical and outcome characteristics are presented. When possible, patients should be treated with a B- lactam.