{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T19:21:19Z","timestamp":1789154479088,"version":"build-2803163510"},"reference-count":25,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T00:00:00Z","timestamp":1683244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Reference Center for complex Bone and Joint Infections"},{"name":"InfectioNimes"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Enterococcal bone and joint infections (BJIs) are reported to have poor outcomes, but there are conflicting results. This study aimed to describe the clinical characteristics and outcomes of patients with enterococcal BJI and to assess the factors associated with treatment failure. We conducted a retrospective cohort study at Nimes University Hospital from January 2007 to December 2020. The factors associated with treatment failure were assessed using a Cox model. We included 90 consecutive adult patients, 11 with native BJIs, 40 with prosthetic joint infections and 39 with orthopedic implant-associated infections. Two-thirds of patients had local signs of infection, but few (9%) had fever. Most BJIs were caused by Enterococcus faecalis (n = 82, 91%) and were polymicrobial (n = 75, 83%). The treatment failure rate was 39%, and treatment failure was associated with coinfection with Staphylococcus\u00a0epidermidis (adjusted hazard ratio = 3.04, confidence interval at 95% [1.31\u20137.07], p = 0.01) and with the presence of local signs of inflammation at the time of diagnosis (aHR = 2.39, CI 95% [1.22\u20134.69], p = 0.01). Our results confirm the poor prognosis of enterococcal BJIs, prompting clinicians to carefully monitor for local signs of infection and to optimize the medical-surgical management in case of coinfections, especially with S. epidermidis.<\/jats:p>","DOI":"10.3390\/microorganisms11051213","type":"journal-article","created":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T08:12:11Z","timestamp":1683274331000},"page":"1213","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Clinical Features and Outcomes of Enterococcal Bone and Joint Infections and Factors Associated with Treatment Failure over a 13-Year Period in a French Teaching Hospital"],"prefix":"10.3390","volume":"11","author":[{"given":"Aur\u00e9lie","family":"Martin","sequence":"first","affiliation":[{"name":"Infectious and Tropical Diseases Department, Nimes University Hospital, 30000 Nimes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1218-9432","authenticated-orcid":false,"given":"Paul","family":"Loubet","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Department, Nimes University Hospital, 30000 Nimes, France"},{"name":"VBIC (Bacterial Virulence and Chronic Infection), INSERM (French Institute of Health and Medical Research), Montpellier University, 30908 Nimes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5367-5058","authenticated-orcid":false,"given":"Florian","family":"Salipante","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology, Public Health, and Innovation in Methodology (BESPIM), Nimes University Hospital, 30000 Nimes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Laffont-Lozes","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Department, Nimes University Hospital, 30000 Nimes, France"},{"name":"Department of Pharmacy, Nimes University Hospital, 30000 Nimes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Mazet","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Department, Nimes University Hospital, 30000 Nimes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9484-0304","authenticated-orcid":false,"given":"Jean-Philippe","family":"Lavigne","sequence":"additional","affiliation":[{"name":"VBIC (Bacterial Virulence and Chronic Infection), INSERM (French Institute of Health and Medical Research), Montpellier University, 30908 Nimes, France"},{"name":"Department of Microbiology and Hospital Hygiene, Nimes University Hospital, 30000 Nimes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Cellier","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Traumatology, Nimes University Hospital, 30000 Nimes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6463-9386","authenticated-orcid":false,"given":"Albert","family":"Sotto","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Department, Nimes University Hospital, 30000 Nimes, France"},{"name":"VBIC (Bacterial Virulence and Chronic Infection), INSERM (French Institute of Health and Medical Research), Montpellier University, 30908 Nimes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7591-0901","authenticated-orcid":false,"given":"Romaric","family":"Larcher","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Department, Nimes University Hospital, 30000 Nimes, France"},{"name":"PhyMedExp (Physiology and Experimental Medicine), INSERM (French Institute of Health and Medical Research), CNRS (French National Centre for Scientific Research), University of Montpellier, 34090 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,5]]},"reference":[{"key":"ref_1","unstructured":"Gilmore, M.S., Clewell, D.B., Ike, Y., and Shankar, N. (2014). Enterococci: From Commensals to Leading Causes of Drug Resistant Infection, Massachusetts Eye and Ear Infirmary."},{"key":"ref_2","unstructured":"Gilmore, M.S., Clewell, D.B., Ike, Y., and Shankar, N. (2014). Enterococci: From Commensals to Leading Causes of Drug Resistant Infection, Massachusetts Eye and Ear Infirmary."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1093\/clinids\/14.6.1173","article-title":"Emergence of Enterococcus as a Significant Pathogen","volume":"14","author":"Moellering","year":"1992","journal-title":"Clin. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.arth.2016.09.017","article-title":"Periprosthetic Joint Infections Caused by Enterococci Have Poor Outcomes","volume":"32","author":"Kheir","year":"2017","journal-title":"J. Arthroplast."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2708","DOI":"10.1007\/s11999-012-2374-8","article-title":"Low Rate of Infection Control in Enterococcal Periprosthetic Joint Infections","volume":"470","author":"Rasouli","year":"2012","journal-title":"Clin. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"285","DOI":"10.7150\/jbji.35683","article-title":"A Population-Based Study on the Treatment and Outcome of Enterococcal Prosthetic Joint Infections. A Consecutive Series of 55 Cases","volume":"4","author":"Thompson","year":"2019","journal-title":"J. Bone Jt. Infect."},{"key":"ref_7","first-page":"59","article-title":"Clinical and Prognostic Features of Prosthetic Joint Infections Caused by Enterococcus Spp","volume":"23","author":"Ascione","year":"2019","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1111\/1469-0691.12721","article-title":"Characteristics of Prosthetic Joint Infections Due to Enterococcus Sp. and Predictors of Failure: A Multi-National Study","volume":"20","author":"Tornero","year":"2014","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Renz, N., Trebse, R., Akg\u00fcn, D., Perka, C., and Trampuz, A. (2019). Enterococcal Periprosthetic Joint Infection: Clinical and Microbiological Findings from an 8-Year Retrospective Cohort Study. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-4691-y"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/j.jbspin.2020.07.012","article-title":"2020 French Recommendations on the Management of Septic Arthritis in an Adult Native Joint","volume":"87","author":"Couderc","year":"2020","journal-title":"Jt. Bone Spine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1302\/0301-620X.103B1.BJJ-2020-2417","article-title":"The EBJIS Definition of Periprosthetic Joint Infection: A Practical Guide for Clinicians","volume":"103-B","author":"McNally","year":"2021","journal-title":"Bone Jt. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/cis803","article-title":"Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of America","volume":"56","author":"Osmon","year":"2013","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1111\/joim.12233","article-title":"Clinical Presentation and Treatment of Orthopaedic Implant-Associated Infection","volume":"276","author":"Zimmerli","year":"2014","journal-title":"J. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e132","DOI":"10.1093\/cid\/cis346","article-title":"2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infectionsa","volume":"54","author":"Lipsky","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_15","unstructured":"(2023, March 01). EUCAST: Clinical Breakpoints and Dosing of Antibiotics. Available online: https:\/\/www.eucast.org\/clinical_breakpoints\/."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A New Method of Classifying Prognostic Comorbidity in Longitudinal Studies: Development and Validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s00402-019-03304-6","article-title":"Risk Factors for Periprosthetic Joint Infection after Total Knee Arthroplasty","volume":"140","author":"Blanco","year":"2020","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/j.artd.2020.07.011","article-title":"Systematic Review and Meta-Analysis of Tobacco Use as a Risk Factor for Prosthetic Joint Infection After Total Hip Replacement","volume":"6","author":"Bojan","year":"2020","journal-title":"Arthroplast. Today"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Koch, J.A., Pust, T.M., Cappellini, A.J., Mandell, J.B., Ma, D., Shah, N.B., Brothers, K.M., and Urish, K.L. (2020). Staphylococcus Epidermidis Biofilms Have a High Tolerance to Antibiotics in Periprosthetic Joint Infection. Life, 10.","DOI":"10.3390\/life10110253"},{"key":"ref_20","first-page":"14","article-title":"Structural Basis of Staphylococcus Epidermidis Biofilm Formation: Mechanisms and Molecular Interactions","volume":"5","author":"Mack","year":"2015","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Ali, L., Goraya, M.U., Arafat, Y., Ajmal, M., Chen, J.-L., and Yu, D. (2017). Molecular Mechanism of Quorum-Sensing in Enterococcus Faecalis: Its Role in Virulence and Therapeutic Approaches. Int. J. Mol. Sci., 18.","DOI":"10.3390\/ijms18050960"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"7156","DOI":"10.1128\/AAC.01988-15","article-title":"Enterococcus Faecalis-Related Prostatitis Successfully Treated with Moxifloxacin","volume":"59","author":"Pilmis","year":"2015","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Naciri, T., Monnin, B., Pantel, A., Roger, C., Kinowski, J.-M., Loubet, P., Lavigne, J.-P., Sotto, A., and Larcher, R. (2022). Outcomes of Beta-Lactam Allergic and Non-Beta-Lactam Allergic Patients with Intra-Abdominal Infection: A Case\u2013Control Study. Antibiotics, 11.","DOI":"10.3390\/antibiotics11121786"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4305","DOI":"10.1128\/AAC.00444-09","article-title":"Pilot Study of Ampicillin-Ceftriaxone Combination for Treatment of Orthopedic Infections Due to Enterococcus Faecalis","volume":"53","author":"Euba","year":"2009","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1086\/591536","article-title":"Outcome of Enterococcal Prosthetic Joint Infection: Is Combination Systemic Therapy Superior to Monotherapy?","volume":"47","author":"Berbari","year":"2008","journal-title":"Clin. Infect. Dis."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/11\/5\/1213\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:29:49Z","timestamp":1760124589000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/11\/5\/1213"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,5]]},"references-count":25,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["microorganisms11051213"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms11051213","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,5]]}}}