Efficacy of cotrimoxazole (Sulfamethoxazole-Trimethoprim) as a salvage therapy for the treatment of bone and joint infections (BJIs)


Autoři: Laurene Deconinck aff001;  Aurélien Dinh aff001;  Christophe Nich aff002;  Thomas Tritz aff003;  Morgan Matt aff001;  Olivia Senard aff001;  Simon Bessis aff001;  Thomas Bauer aff004;  Martin Rottman aff005;  Jérome Salomon aff001;  Frédérique Bouchand aff006;  Benjamin Davido aff001
Působiště autorů: Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France aff001;  Service d’Orthopédie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France aff002;  Pharmacie Hospitalière, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Boulogne-Billancourt, France aff003;  Service d’Orthopédie, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Boulogne-Billancourt, France aff004;  Laboratoire de Microbiologie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France aff005;  Pharmacie Hospitalière, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France aff006
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224106

Souhrn

Introduction

Cotrimoxazole (Sulfamethoxazole-Trimethoprim, SXT) has interesting characteristics for the treatment of bone and joint infection (BJI): a broad spectrum of activity with adequate bone diffusion and oral and intravenous formulations. However, its efficacy and safety in BJIs are poorly documented and its use remains limited.

Methods

We conducted a retrospective study in 2 reference centers for BJIs from 2013 to 2018 among patients treated with SXT for a BJI. Data were collected from patient’s medical charts. Outcomes and adverse events were evaluated at day (D)7, D45 and D90.

Results

We analyzed 51 patients with a mean age of 60 ± 20 (SD) years of which 76% presented with an orthopedic device infection (ODI). Gram-negative bacilli (GNB) were involved in 47% of BJIs (n = 24). Moreover, they were often polymicrobial infections (41%). Doses of SXT ranged from 800/160mg bid (61%; n = 31) to 800/160mg tid (39%; n = 20). Median SXT treatment duration was 45 days (IQR 40–45). SXT was part of a dual therapy in 84% of patients (n = 43), associated mainly with fluoroquinolones (n = 17) or rifampicin (n = 14). Outcome was favorable at D7 in 98% (n = 50), at D45 in 88.2% (n = 45) and at D90 in 78.4% (n = 40). The second agent combined with SXT was not an independent factor of favorable outcome (p = 0.97). Adverse events were reported in 8% (n = 4) of patients, with a median of 21 days (IQR 20–30) from SXT initiation and led to discontinuation (n = 3).

Conclusion

SXT appears to be effective for treatment of BJIs as a salvage therapy, even in GNB or polymicrobial infection, including ODI. Further data are needed to confirm SXT efficacy as an alternative oral regimen in BJIs.

Klíčová slova:

Adverse events – Antibiotics – Enterobacteriaceae – Methicillin-resistant Staphylococcus aureus – Orthopedic surgery – Surgical and invasive medical procedures – Prosthetic device infections – Polymicrobial infections


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