Format

Send to

Choose Destination
J Infect. 2018 Aug 7. pii: S0163-4453(18)30241-X. doi: 10.1016/j.jinf.2018.07.014. [Epub ahead of print]

Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention.

Author information

1
Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. Electronic address: m.wouthuyzen-bakker@umcg.nl.
2
Department of Infectious Diseases and IntensiveCare Medicine, Rennes University Hospital, Rennes, France.
3
Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England.
4
Infectious Disease Service, IDIBELL-Hospital Universitari Bellvitge, Barcelona, Spain.
5
Rothman Institute at Thomas Jefferson University Hospital, Philidelphia, United States.
6
Rothman Institute at Thomas Jefferson University Hospital, Philidelphia, United States; Department of Orthopaedic Surgery, Tel Aviv University, Tel Aviv, Israel.
7
Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
8
Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marques de Valdecilla-IDIVAL, Cantabria, Spain.
9
Department of Infectious Diseases, University Hospital Gustave Dron Hospital, Tourcoing, France.
10
Inflammation center, Infectious Diseases, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Finland.
11
Department of Internal Medicine, Hospital Universitario Principe de Asturias, Madrid, Spain.
12
Department of Internal Medicine-Emergency, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain.
13
Department of Internal Medicine. Hospital Universitario 12 de Octubre. Instituto de Investigación i+12, Madrid, Spain.
14
Department of Prosthetic Joint Replacement and Rehabilitation Center, Humanitas Research Hospital and Humanitas University, Milan, Italy.
15
Department of Infectious Diseases, Medical Academy, Lithuanian University of Health Sciences, Kaunas Clinical Hospital, Kaunas, Lithuania.
16
Department of Microbiology, Antwerp University Hospital (UZA), University of Antwerp, Edegem, Belgium.
17
The Department of Infectious Diseases, Northern Health, Melbourne, Australia; The University of Melbourne, Northern Clinical School, Melbourne, Australia.
18
Service for Bone Infections, Valdoltra Orthopaedic Hospital, Ankaran, Slovenia.
19
Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brasil.
20
Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
21
Servicio de Infectología, Hospital Italiano de Mendoza, Mendoza, Argentina.
22
Unidad Clínica de Enfermedades Infecciosa y Microbiología, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain.
23
Nationales Referenzzentrum für Surveillance von nosokomialen Infektionen am Institut für Hygiene und Umweltmedizin Charité-Universitätsmedizin, Berlin, Germany; LADR, GmbH MVZ, Neuruppin, Germany.
24
Institute of Medical Microbiology and Hospital Hygiene University Hospital, Heinrich-Heine-University. Düsseldorf, Germany.
25
Infectious Diseases Unit, Parc Sanitari Sant Joan de Deu, Sant Boi, Barcelona, Spain.
26
Infectious Diseases and Clinical Microbiology Department, Ankara Yildirim Beyazit University, Ataturk Training & Research Hospital, Ankara, Turkey.
27
Infectious Diseases Section, Internal Medicine Service, Hospital Italiano de Buenos Aires, Argentina.
28
Department of Infectious Diseases and IntensiveCare Medicine, Rennes University Hospital, Rennes, France; Great West Reference centers for Complex Bone and Joint Infections (CRIOGO), France.
29
Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain.

Abstract

OBJECTIVES:

Debridement, antibiotics and implant retention (DAIR) is the recommended treatment for all acute prosthetic joint infections (PJI), but its efficacy in patients with late acute (LA) PJI is not well described.

METHODS:

Patients diagnosed with LA PJI between 2005 and 2015 were retrospectively evaluated. LA PJI was defined as the development of acute symptoms (≤ 3 weeks) occurring ≥ 3 months after arthroplasty. Failure was defined as: (i) the need for implant removal, (ii) infection related death, (iii) the need for suppressive antibiotic therapy and/or (iv) relapse or reinfection during follow-up.

RESULTS:

340 patients from 27 centers were included. The overall failure rate was 45.0% (153/340). Failure was dominated by Staphylococcus aureus PJI (54.7%, 76/139). Significant independent preoperative risk factors for failure according to the multivariate analysis were: fracture as indication for the prosthesis (odds ratio (OR) 5.4), rheumatoid arthritis (OR 5.1), age above 80 years (OR 2.6), male gender (OR 2.0) and C-reactive protein > 150 mg/L (OR 2.0). Exchanging the mobile components during DAIR was the strongest predictor for treatment success (OR 0.35).

CONCLUSION:

LA PJIs have a high failure rate. Treatment strategies should be individualized according to patients' age, comorbidity, clinical presentation and microorganism causing the infection.

KEYWORDS:

Acute; Hematogenous; Prosthetic joint infection; Risk factors, failure

PMID:
30092305
DOI:
10.1016/j.jinf.2018.07.014

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center