Table 1 Patient’s characteristics and risk factors for native methicillin-susceptible Staphylococcus aureus bone and joint infection treatment failure
Risk factor for treatment failure | Total (n = 66) | Treatment failure (n = 16) | Favourable outcome (n = 50) | p | Univariate analysis | |||
|---|---|---|---|---|---|---|---|---|
OR (95%CI) | p | |||||||
Demographic characteristics | ||||||||
Sex (male) | 42 (63.6%) | 10 (62.5%) | 32 (64.0%) | 0.913 | 0.938 (0.292-3.006) | 0.938 | ||
Age (years) | 61.2 (45.9-71.9) | 61.2 (48.5-69.6) | 60.4 (43.5-76.5) | 0.828 | 1.119 (0.820-1.525)* | 0.479 | ||
Comorbidity | ||||||||
Modified Charlson score | 3.0 (0.0-5.0) | 4.0 (2.5-5.0) | 2.0 (0.0-4.0) | 0.163 | 1.093 (0.907-1.318) | 0.351 | ||
Modified Charlson score > 2 | 34 (51.5%) | 12 (75.0%) | 22 (44.0%) | 0.044 | 3.818 (1.081-13.486) | 0.037 | ||
Obesity (BMI > 30 kg/m2) | 13 (20.0%) | 3 (20.0%) | 10 (20.0%) | 1.000 | 1.000 (0.236-4.231) | 1.000 | ||
Denutrition (BMI < 18 kg/m2) | 3 (4.6%) | 1 (6.7%) | 2 (4.0%) | 1.000 | 1.714 (0.145-20.332) | 0.669 | ||
Diabetes | 11 (16.7%) | 6 (37.5%) | 5 (10.0%) | 0.018 | 5.400 (1.372-21.260) | 0.016 | ||
Immunodepression | 8 (12.1%) | 3 (18.8%) | 5 (10.0%) | 0.390 | 2.077 (0.437-9.871) | 0.358 | ||
Nephropathy | 10 (15.2%) | 3 (18.8%) | 7 (14.0%) | 0.695 | 1.418 (0.320-6.277) | 0.646 | ||
Hepatopathy | 2 (3.0%) | 2 (12.5%) | 0 (0%) | 0.056 | NC | NC | ||
Chronic pulmonary disease | 12 (18.2%) | 4 (25.0%) | 8 (16.0%) | 0.465 | 1.750 (0.449-6.825) | 0.420 | ||
Chronic heart failure | 5 (7.6%) | 0 (0%) | 5 (10.0%) | 0.325 | NC | NC | ||
Chronic inflammatory disease | 7 (10.6%) | 2 (12.5%) | 5 (10.0%) | 1.000 | 1.286 (0.224-7.370) | 0.778 | ||
Neoplasm, hemopathy | 7 (10.6%) | 1 (6.3%) | 6 (12.0%) | 0.674 | 0.489 (0.054-4.397) | 0.523 | ||
Dementia | 1 (1.5%) | 1 (6.3%) | 0 (0%) | 0.242 | NC | NC | ||
BJI type | ||||||||
Arthritis | 15 (22.7%) | 3 (18.8%) | 12 (24.0%) | 0.747 | 0.731 (0.178-3.003) | 0.731 | ||
Osteomyelitis | 19 (28.8%) | 8 (50.0%) | 11 (22.0%) | 0.054 | 3.545 (1.082-11.615) | 0.037 | ||
Vertebral osteomyelitis | 32 (48.5%) | 5 (31.3%) | 27 (54.0%) | 0.195 | 0.387 (0.117-1.279) | 0.120 | ||
BJI mechanism | ||||||||
Haematogenous | 40 (60.6%) | 8 (50.0%) | 32 (64.0%) | 0.480 | 0.563 (0.180-1.754) | 0.321 | ||
Inoculation | 22 (33.3%) | 7 (43.8%) | 15 (30.0%) | 0.475 | 1.815 (0.570-5.779) | 0.313 | ||
Contiguity | 4 (6.1%) | 1 (6.3%) | 3 (6.0%) | 1.000 | 1.044 (0.101-10.806) | 0.971 | ||
BJI diagnosis | ||||||||
Fever | 43 (65.2%) | 10 (62.5%) | 33 (66.0%) | 1.000 | 0.859 (0.267-2.764) | 0.798 | ||
Fistula | 18 (27.3%) | 7 (43.8%) | 11 (22.0%) | 0.112 | 2.758 (0.836-9.092) | 0.096 | ||
Abscess | 33 (50.0%) | 7 (43.8%) | 26 (52.0%) | 0.775 | 0.718 (0.231-2.229) | 0.566 | ||
Chronic BJI (evolution > 4 weeks) | 28 (42.4%) | 8 (50.0%) | 20 (40.0%) | 0.680 | 1.500 (0.484-4.651) | 0.483 | ||
Delay from symptoms to diagnosis (weeks) | 2.1 (0.0-10.3) | 2.6 (0.0-34.4) | 2.1 (0.5-9.8) | 0.905 | 1.026 (0.996-1.057) | 0.095 | ||
Polymicrobial BJI | 10 (15.2%) | 3 (18.8%) | 7 (14.0%) | 0.695 | 1.418 (0.320-6.277) | 0.646 | ||
Infective endocarditis | 4 (6.1%) | 0 (0%) | 4 (8.0%) | 0.565 | NC | NC | ||
Biological inflammatory syndrome | 58 (87.9%) | 16 (100%) | 42 (84.0%) | 0.183 | NC | NC | ||
Maximal CRP value (mg/L) | 152.7 (52.0-317.8) | 145.0 (75.3-317.3) | 154.7 (52.0-325.9) | 0.994 | 1.000 (0.996-1.004) | 0.931 | ||
Maximal WBC count value (/mm3) | 10,200 (7,720-14,920) | 11,000 (10,200-16,280) | 9,710 (7,350-14,770) | 0.100 | 1.058 (0.961-1.164) | 0.251 | ||
Maximal neutrophil count value (/mm3) | 7,600 (5,200-11,970) | 9,300 (6,740-13,470) | 7,380 (5,200-11,400) | 0.292 | 1.056 (0.957-1.165) | 0.277 | ||
Chronic sepsis on pathological examination | 9/21 (47.4%) | 2/3 (66.7%) | 7/16 (43.8%) | 0.582 | 2.571 (0.192-34.473) | 0.476 | ||
Surgical treatment | 37 (56.1%) | 11 (68.8%) | 26 (52.0%) | 0.377 | 2.031 (0.615-6.701) | 0.245 | ||
Delay from symptoms to surgery (days) | 3 (0–12.5) | 0 (0–9) | 4 (0–12) | 0.402 | 0.999 (0.994-1.004) | 0.632 | ||
Antibiotic use | ||||||||
Delay from diagnosis to specialist referral (days) | 4.9 (0.0-23.1) | 6.3 (0.7-91.0) | 4.9 (0.0-18.5) | 0.445 | 1.102 (1.003-1.211) | 0.043 | ||
i.v.treatment | 59 (89.4%) | 13 (81.3%) | 46 (92.0%) | 0.347 | 0.377 (0.075-1.901) | 0.237 | ||
i.v.treatment duration (weeks) | 7.1 (4.9-11.7) | 9.1 (5.3-16.4) | 7.0 (4.6-9.4) | 0.297 | 1.037 (0.986-1.091) | 0.156 | ||
Bitherapy | 66 (100%) | 16 (100%) | 50 (100%) | 1.000 | NC | NC | ||
Bitherapy duration (weeks) | 25.6 (15.0-32.1) | 27.0 (17.4-38.5) | 25.1 (15.1-31.1) | 0.533 | 1.016 (0.983-1.050) | 0.345 | ||
Initial anti-staphylococcal bitherapy | 53 (81.5%) | 12 (75.0%) | 41 (83.7%) | 0.719 | 0.585 (0.150-2.285) | 0.441 | ||
Initial anti-MSSA bitherapy | 40 (61.5%) | 8 (50.0%) | 32 (65.3%) | 0.480 | 0.531 (0.169-1.666) | 0.278 | ||
Biological follow-up | ||||||||
1 month CRP level | 13.0 (3.6-36.0) | 13.3 (7.4-70.4) | 11.0 (3.2-31.9) | 0.296 | 1.006 (0.994-1.018) | 0.315 | ||
Decrease in CRP level at 1 month < 50% | 9 (13.8%) | 4 (26.7%) | 5 (10.0%) | 0.204 | 3.273 (0.752-14.245) | 0.114 | ||
1 month CRP level < 10 mg/L | 29 (44.6%) | 5 (33.3%) | 24 (48.0%) | 0.377 | 0.542 (0.162-1.814) | 0.320 | ||