Cirrhotic patients with bone and joint infections: A 10-year cohort study from a reference center

Abstract

Introduction: Bone and joint infections (BJI) require long-term and frequently high-dose antimicrobial treatment, often with heightened risk of drug-drug or drug-disease interactions. However, in some cases, notably regarding cirrhotic patients, these infections have yet to be adequately described. Cirrhosis is a major cause of end-stage chronic liver disease, entailing massive disorders in hepatic metabolism and a high rate of infections and comorbidities. We aimed to characterize the cirrhosis - BJI population treated over the last 10 years in our reference centre.

Material and methods: A descriptive monocentric retrospective study analysed routine care data extracted from our computer files. Patients labelled with a chronic hepatic disease were included. Biological, clinical and survival rate were researched. Drug-drug and drug-disease interactions were compiled and analysed using the exposure ratio, according to the Child-Pugh scale.

Results: Eighteen patients were included, for 28 presentations. Twelve were Child-Pugh B or C. Only two out of the 18 patients had their antimicrobial dosage adjusted. No patient who had not received the recommended dose adjustment was admitted to the emergency department or for consultation for an antibiotic-related adverse event. During the 1st year, two patients (11.1 %) required hospitalization for revision surgery. Neither relapsed a second time. Six patients (33.3 %) died during follow-up, but none of the deaths were related to infection (four cancers, two ischemic events).

Conclusion: We have shown that cirrhotic patients with BJI are infected with the same pathogens as the general population. Dose adjustments remain unclear, and further studies are required. BJI infections are particularly complex, and require enhanced multidisciplinary management.

Keywords: Bone and Joint Infection; Cirrhosis; Drug-related problems; Drug–drug interactions.