JBJI Journal of Bone and Joint Infection JBJI J. Bone Joint Infect. 2206-3552 Ivyspring Göttingen, Germany 10.7150/jbji.21846 Analysis Of The KLIC-score; An Outcome Predictor Tool For Prosthetic Joint Infections Treated With Debridement, Antibiotics And Implant Retention Duffy Sean DX 1 Ahearn Nathanael 1 Darley Elizabeth SR 1 Porteous Andrew J 1 Murray James R 1 Howells Nicholas R 1 Avon Orthopaedic Centre, Southmead Hospital, Bristol 27 07 2018 3 3 150 155 Copyright: © 2018 Sean DX Duffy et al. 2018 This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/ This article is available from https://jbji.copernicus.org/articles/3/150/2018/jbji-3-150-2018.html The full text article is available as a PDF file from https://jbji.copernicus.org/articles/3/150/2018/jbji-3-150-2018.pdf

<p class="p p-first" id="__p2"><strong>Background:</strong> Debridement, antibiotics and implant retention (DAIR) forms the primary treatment modality for early prosthetic joint infection (PJI). The KLIC score has been proposed as a risk stratification tool for use in predicting outcome of prosthetic knee infections. Our aim was to determine the accuracy of this scoring system at an independent tertiary PJI centre in a typical DAIR population.</p><p id="__p3"><strong>Methods:</strong> Between 2008 and 2015, patients with infected knee prostheses treated with DAIR were identified. The patient notes and blood tests were reviewed retrospectively and the 'KLIC-score' was calculated and correlated with outcome. The end point for early failure was defined as: 1) the need for unscheduled surgery, 2) infection-related death ≤12 months from debridement or 3) the need for suppressive antibiotic treatment.</p><p id="__p4"><strong>Results:</strong> 59 patients received DAIR procedures for knee PJI. Treatment was successful in 41 patients (69%) with early failure in 18 patients (31%). Patients deemed high-risk (KLIC-score ≥7) had notably higher failure rates (60%) than those scoring &lt;7 (28%). No relationship can be drawn between KLIC-scores of &lt;7 and failure rates.</p><p class="p p-last" id="__p5"><strong>Conclusions:</strong> The KLIC-score applied retrospectively was able to predict patients with the highest risk of early failure but provides little information in patients with scores of &lt;7.</p>

 References National Joint Registry, 13th Annual Report 2016. NJR Reports. 2016. (Available online at. www.njrcentre.org.uk) Public Health England. Surgical site infections (SSI) surveillance: NHS hospitals in England. 2014/15. London: Public Health England, December; 2015. [Google Scholar] Kurtz SM, Lau E. et al. Infection Burden for Hip and Knee Arthroplasty in the United States. J Arthroplasty. 2008;23:984–91. Byren I, Bejon P. et al. One Hundred and Twelve Infected Arthroplasties Treated With 'Dair' (Debridement Antibiotics and Implant Retention): Antibiotic Duration and Outcome. J Antimicrob Chemother. 2009;63:1264–71. [PMC free article] Parvizi J, Gehrke T. International Consensus on Periprosthetic Joint Infection: Let Cumulative Wisdom be a Guide. J Bone Joint Surg Am. 2014;96:441. Cochran AR, Ong KL. et al. Risk of Reinfection After Treatment of Infected Total Knee Arthroplasty. J Arthroplasty. 2016;31:156–61. Haleem AA, Berry DJ, Hansen AD. Mid-Term to Long-Term Followup of Two-Stage Reimplantation for Infected Total Knee Arthroplasty. Clin Orthop Relat Res. 2004;428:35–39. Goldman RT, Scuderi GR, Insall JN. 2-Stage Reimplantation for Infected Total Knee Replacement. Clin Orthop Relat Res. 1996;331:118–24. Silva M, Tharani R, Schmalzried TP. Results of Direct Exchange or Debridement of the Infected Total Knee Arthroplasty. Clin Orthop Relat Res. 2002;404:125–31. Kuiper JW, Vos SJ. et al. Prosthetic Joint-Associated Infections Treated With Dair (Debridement Antibiotics Irrigation and Retention): Analysis of Risk Factors and Local Antibiotic Carriers in 91 Patients. Acta Orthop. 2013;84:380–6. [PMC free article] Lora-Tamayo J, Murillo O. et al. A Large Multicenter Study of Methicillin-Susceptible and Methicillin-Resistant Staphylococcus Aureus Prosthetic Joint Infections Managed With Implant Retention. Clin Infect Dis. 2013;56:182–194. Marculescu CE, Berbari EF. et al. Outcome of Prosthetic Joint Infections Treated With Debridement and Retention of Components. Clin Infect Dis. 2006;42:471–78. Meehan AM, Osmon DR. et al. Outcome of Penicillin-Susceptible Streptococcal Prosthetic Joint Infection Treated With Debridement and Retention of the Prosthesis. Clin Infect Dis. 2003;36:845–49. Zimmerli W, Widmer AF. et al. Role of Rifampin for Treatment of Orthopedic Implant-Related Staphylococcal Infections: A Randomized Controlled Trial. Foreign-Body Infection (Fbi) Study Group. JAMA. 1998;279:1537–41. Tornero E, Morata L. et al. Klic-Score for Predicting Early Failure in Prosthetic Joint Infections Treated With Debridement Implant Retention and Antibiotics. Clin Microbiol Infect. 2015;21:786.e9–786.e17. The British Society for Antimicrobial Chemotherapy. 2015;14. Atkins BL, Athanasou N. et al. Prospective Evaluation of Criteria for Microbiological Diagnosis of Prosthetic-Joint Infection At Revision Arthroplasty. The Osiris Collaborative Study Group. J Clin Microbiol. 1998;36:2932–9. [PMC free article] Puhto AP, Puhto TM. et al. Two-Stage Revision for Prosthetic Joint Infection: Outcome and Role of Reimplantation Microbiology in 107 Cases. J Arthroplasty. 2014;29:1101–4. Evans RP. Successful Treatment of Total Hip and Knee Infection With Articulating Antibiotic Components: A Modified Treatment Method. Clin Orthop Relat Res. 2004;427:37–46. Sherrell JC, Fehring TK. et al. The Chitranjan Ranawat Award: Fate of Two-Stage Reimplantation After Failed Irrigation and Débridement for Periprosthetic Knee Infection. Clin Orthop Relat Res. 2011;469:18–25. [PMC free article] Tschudin-Sutter S, Frei R. et al. Validation of a Treatment Algorithm for Orthopaedic Implant-Related Infections With Device-Retention-results From a Prospective Observational Cohort Study. Clin Microbiol Infect. 2016;22:457.e1–9. Tattevin P, Crémieux AC. et al. Prosthetic Joint Infection: When Can Prosthesis Salvage be Considered. Clin Infect Dis. 1999;29:292–95. Brandt CM, Sistrunk WW. et al. Staphylococcus Aureus Prosthetic Joint Infection Treated With Debridement and Prosthesis Retention. Clin Infect Dis. 1997;24:914–19. Schoifet SD, Morrey BF. Treatment of Infection After Total Knee Arthroplasty By Débridement With Retention of the Components. J Bone Joint Surg Am. 1990;72:1383–90. Wilson MG, Kelley K, Thornhill TS. Infection as a Complication of Total Knee-Replacement Arthroplasty. Risk Factors and Treatment in Sixty-Seven Cases. J Bone Joint Surg Am. 1990;72:878–83. Peel TN, Buising KL. et al. Outcome of Debridement and Retention in Prosthetic Joint Infections By Methicillin-Resistant Staphylococci With Special Reference to Rifampin and Fusidic Acid Combination Therapy. Antimicrob Agents Chemother. 2013;57:350–5. [PMC free article] Buller LT, Sabry FY. et al. The Preoperative Prediction of Success Following Irrigation and Debridement With Polyethylene Exchange for Hip and Knee Prosthetic Joint Infections. J Arthroplasty. 2012;27:857–64.e1. -4.