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Journal of Bone and Joint Infection An open-access journal of the European Bone and Joint Infection Society and the MusculoSkeletal Infection Society
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Volume 5, issue 3
J. Bone Joint Infect., 5, 110–117, 2020
https://doi.org/10.7150/jbji.43254
© Author(s) 2020. This work is distributed under
the Creative Commons Attribution 4.0 License.
J. Bone Joint Infect., 5, 110–117, 2020
https://doi.org/10.7150/jbji.43254
© Author(s) 2020. This work is distributed under
the Creative Commons Attribution 4.0 License.

Original full-length article 12 Apr 2020

Original full-length article | 12 Apr 2020

Minocycline Combined with Vancomycin for the Treatment of Methicillin-Resistant Coagulase-Negative Staphylococcal Prosthetic Joint Infection Managed with Exchange Arthroplasty

Géraldine Bart1, Valérie Zeller1,2, Younes Kerroumi2, Beate Heym2,3, Vanina Meyssonnier1,2, Nicole Desplaces2, Marie Dominique Kitzis5, Jean Marc Ziza1,2, and Simon Marmor2,4 Géraldine Bart et al.
  • 1Service de Médecine Interne et Rhumatologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
  • 2Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
  • 3Laboratoire des Centres de Santé et Hôpitaux d'Ile de France, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
  • 5Laboratoire de Microbiologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
  • 4Service de Chirurgie Osseuse et Traumatologique; Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France

Keywords: prosthetic joint infection, methicillin-resistant Staphylococcus, minocycline, rifampicin

Abstract. Introduction: Treatment of methicillin-resistant (MR) staphylococcal prosthetic joint infections (PJIs) remains a matter of discussion, with vancomycin-rifampin combination therapy being the preferred treatment for DAIR and one-stage exchange arthroplasty strategies. This study analyzes the outcomes of patients with chronic methicillin-resistant coagulase-negative staphylococcal PJIs treated with vancomycin-minocycline combination therapy.

Methods: This prospective, single center cohort study included all chronic MR coagulase-negative staphylococcal PJIs (01/2004-12/2014) treated with exchange arthroplasty and at least 4 weeks of minocycline-vancomycin. The following endpoints were considered: reinfection including relapse (same microorganism) and a new infection (different microorganism) and PJI-related deaths. Their outcomes were compared with PJIs treated with rifampin-vancomycin during the same period.

Results: Thirty-four patients (median age, 69 years) with 22 hip and 12 knee arthroplasty infections were included. Sixteen (47%) had previously been managed in another center. Median vancomycin MIC of strains was 3 mg/L. Nineteen underwent one-stage, 15 two-stage exchange arthroplasty. After a median [IQR] follow-up of 43 [26-68] months, 2 patients relapsed and 6 developed a new PJI. Compared to 36 rifampin-vancomycin treated PJIs, relapse- or reinfection-free survival rates didn't differ, but more new infections developed in the minocycline group (6 vs 3; P 0.3).

Conclusions: Minocycline-vancomycin combination therapy for chronic MR coagulase-negative staphylococcal PJIs seems to be an interesting therapeutic alternative.

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