Linezolid versus daptomycin treatment for periprosthetic joint infections: a retrospective cohort study
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(2019) 14:334
RESEARCH ARTICLE
Open Access
Linezolid versus daptomycin treatment for periprosthetic joint infections: a retrospective cohort study Masahiro Sawada, Kenichi Oe*, Masayuki Hirata, Hiroshi Kawamura, Narumi Ueda, Tomohisa Nakamura, Hirokazu Iida and Takanori Saito
Abstract Background: Linezolid (LZD) and daptomycin (DAP) are predominantly used to target gram-positive pathogens; however, treatment effectiveness and adverse reactions for periprosthetic joint infections (PJIs) remain unknown. The aim of this study was to compare the effectiveness and adverse reactions of LZD and DAP for PJIs. Methods: This study retrospectively evaluated 82 patients between June 2009 and December 2017, to compare the effectiveness of LZD (group L, n = 39) and DAP (group D, n = 43) for treatment of PJIs harboring gram-positive microorganisms. Surgical options used with LZD or DAP therapy included implant retention, implant removal, and a shift to another appropriate antibiotic. Infection control was defined as not requiring implant removal after the final treatment. Results: Gram-positive pathogens were isolated from 72% of group L and 70% of group D patients, respectively. Whole infection control rates against gram-positive pathogens in groups L and D were 79% and 77%, respectively. Furthermore, infection control rates were 94% and 58% in group L and 75% and 80% in group D, without and with implant removal, respectively. Significantly higher clinical success rates and lower adverse event rates were observed in group D, including higher red blood cell and platelet counts and lower C-reactive protein (CRP) levels. Conclusions: Although the effectiveness of LZD and DAP was equivalent in terms of infection control rates for refractory PJIs with gram-positive pathogens, DAP therapy significantly decreased CRP levels and caused fewer adverse events than LZD treatment. Keywords: Linezolid, Daptomycin, Periprosthetic joint infection, Implant retention, Adverse event rates
Background According to the Nordic Arthroplasty Register Association, the number of periprosthetic joint infections (PJIs) is increasing [1], and there are differences between PJIs and other infections with regard to the pathogenesis and treatment strategies. In PJIs, subclinical infections frequently occur by conventional diagnostic procedures because the bacteria subsist within biofilms on implant surfaces [2]. Therefore, implant removal is generally required for the treatment, and the probability of implant retention is limited [3]. Although the gold standard for managing PJIs includes both implant removal and * Correspondence: [email protected] Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
thorough debridement, accompanied by an appropriate antibiotic therapy, there is no consensus for the treatment of PJIs regarding the choice of specific antibiotic therapy. Furthermore, the treatment of PJIs should target gram-positive pathogens because such organisms cause the majority of PJIs an
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