J Bone Jt Infect 2020; 5(3):110-117. doi:10.7150/jbji.43254

Research Paper

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, Simon Marmor2,4

1. Service de Médecine Interne et Rhumatologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
2. Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
3. Laboratoire des Centres de Santé et Hôpitaux d'Ile de France, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
4. Service de Chirurgie Osseuse et Traumatologique; Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
5. Laboratoire de Microbiologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France.

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Citation:
Bart G, Zeller V, Kerroumi Y, Heym B, Meyssonnier V, Desplaces N, Kitzis MD, Ziza JM, Marmor S. Minocycline Combined with Vancomycin for the Treatment of Methicillin-Resistant Coagulase-Negative Staphylococcal Prosthetic Joint Infection Managed with Exchange Arthroplasty. J Bone Jt Infect 2020; 5(3):110-117. doi:10.7150/jbji.43254. Available from http://www.jbji.net/v05p0110.htm

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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.

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