References

JBJI

Journal of Bone and Joint Infection

JBJI

J. Bone Joint Infect.

2206-3552

Ivyspring

Göttingen, Germany

10.7150/jbji.37757

Evaluation One Year after DAIR Treatment in 91 Suspected Early Prosthetic Joint Infections in Primary Knee and Hip Arthroplasty

Jacobs

Anouk M.E.

¹ ² Valkering

Lucia J.J.

¹ Bénard

Menno

² Meis

Jacques F.

³ ⁴ Goosen

Jon H.M.

Department of Orthopaedic Surgery, Prosthetic Joint Infection Unit, Sint Maartenskliniek, Nijmegen, the Netherlands

Sint Maartenskliniek Research, Sint Maartenskliniek, Nijmegen, the Netherlands

Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands

Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands

15 10 2019

4 5 238 244

2019

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/4/238/2019/jbji-4-238-2019.html

The full text article is available as a PDF file from https://jbji.copernicus.org/articles/4/238/2019/jbji-4-238-2019.pdf

Introduction: Early recognition and appropriate initial treatment with debridement, antibiotics and implant retention (DAIR) if a suspicion of an early prosthetic joint infection (PJI) is present can eradicate infection on first attempt and prevent implant failure. We evaluated the outcome after 1 year of patients treated with DAIR after primary total knee arthroplasty (TKA) or total hip arthroplasty (THA). Furthermore, we determined preoperative, microbiology, and treatment factors related to failure after DAIR.Methods: A retrospective cohort study was assembled with 91 patients undergoing DAIR with a high suspicion of an early PJI. Records were reviewed for demographics, preoperative laboratory results, microbiological data, given treatment and postoperative follow-up. The primary outcome was infection-free implant survival at 1 year. Repeated DAIR was not considered as treatment failure.Results: The rate of infection-free implant survival following DAIR in a suspected early PJI was 85% (95% confidence intervals (CI) 78-91). Cultures remained negative in 20 patients, with no occurrence of infection during follow-up. A higher failure rate was seen in early PJI caused by Enterococcus faecalis (p=0.04). Multivariate analysis showed a statistically significant association between treatment failure and high C-reactive protein level (CRP >100) (odds ratio 10.0, 95% CI [1.5-70]) and multiple DAIR procedures (≥2) (odds ratio 5.0, 95%CI [1.1-23]).Conclusion: If an early PJI is suspected DAIR is the appointed treatment with up to 2 debridement procedures. Since culture-negative DAIRs were not related to any complications during follow-up, overtreatment of suspected PJI seems to do no significant harm with respect to implant failure.

References 0

Bozic KJ, Kurtz SM, Lau E. et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468(1):45–51. [PMC free article]

Bozic KJ, Kurtz SM, Lau E. et al. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91(1):128–33.

Blom AW, Brown J, Taylor AH. et al. Infection after total knee arthroplasty. J Bone Joint Surg Br. 2004;86(5):688–91.

Blom AW, Taylor AH, Pattison G, Whitehouse S, Bannister GC. Infection after total hip arthroplasty. The Avon experience. J Bone Joint Surg Br. 2003;85(7):956–9.

Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am. 2005;87(8):1746–51.

Trampuz A, Zimmerli W. New strategies for the treatment of infections associated with prosthetic joints. Curr Opin Investig Drugs. 2005;6(2):185–90.

Kuiper JW, Willink RT, Moojen DJ, van den Bekerom MP, Colen S. Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts. World J Orthop. 2014;5(5):667–76. [PMC free article]

Osmon DR, Berbari EF, Berendt AR. et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56(1):e1–e25.

Kuiper JW, Vos SJ, Saouti R. 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(4):380–6. [PMC free article]

Aboltins C, Dowsey M, Peel T, Lim WK, Choong P. Good quality of life outcomes after treatment of prosthetic joint infection with debridement and prosthesis retention. J Orthop Res. 2016;34(5):898–902.

Byren I, Bejon P, Atkins BL. 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(6):1264–71. [PMC free article]

Letouvet B, Arvieux C, Leroy H. et al. Predictors of failure for prosthetic joint infections treated with debridement. Med Mal Infect. 2016;46(1):39–43.

Puhto AP, Puhto T, Niinimaki T. et al. Predictors of treatment outcome in prosthetic joint infections treated with prosthesis retention. Int Orthop. 2015;39(9):1785–91.

Tornero E, Morata L, Martinez-Pastor JC. et al. Importance of selection and duration of antibiotic regimen in prosthetic joint infections treated with debridement and implant retention. J Antimicrob Chemother. 2016;71(5):1395–401.

Buller LT, Sabry FY, Easton RW, Klika AK, Barsoum WK. The preoperative prediction of success following irrigation and debridement with polyethylene exchange for hip and knee prosthetic joint infections. J Arthroplasty. 2012;27(6):857–64. e1-4.

Senneville E, Joulie D, Legout L. et al. Outcome and predictors of treatment failure in total hip/knee prosthetic joint infections due to Staphylococcus aureus. Clin Infect Dis. 2011;53(4):334–40. [PMC free article]

Choong PF, Dowsey MM, Carr D, Daffy J, Stanley P. Risk factors associated with acute hip prosthetic joint infections and outcome of treatment with a rifampinbased regimen. Acta Orthop. 2007;78(6):755–65.

Tornero E, Morata L, Martinez-Pastor JC. et al. KLIC-score for predicting early failure in prosthetic joint infections treated with debridement, implant retention and antibiotics. Clin Microbiol Infect. 2015;21(8):786. e9- e17.

Lora-Tamayo J, Murillo O, Iribarren JA. 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(2):182–94.

Cobo J, Miguel LG, Euba G. et al. Early prosthetic joint infection: outcomes with debridement and implant retention followed by antibiotic therapy. Clin Microbiol Infect. 2011;17(11):1632–7.

Betz M, Abrassart S, Vaudaux P. et al. Increased risk of joint failure in hip prostheses infected with Staphylococcus aureus treated with debridement, antibiotics and implant retention compared to Streptococcus. Int Orthop. 2015;39(3):397–401.

Rodriguez-Pardo D, Pigrau C, Lora-Tamayo J. et al. Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study. Clin Microbiol Infect. 2014;20(11):O911–9.

Duijf SV, Vos FJ, Meis JF, Goosen JH. Debridement, antibiotics and implant retention in early postoperative infection with Enterococcus sp. Clin Microbiol Infect. 2015;21(5):e41–2.

Kheir MM, Tan TL, Higuera C. et al. Periprosthetic Joint Infections Caused by Enterococci Have Poor Outcomes. J Arthroplasty. 2017;32(3):933–47.

Tornero E, Senneville E, Euba G. et al. Characteristics of prosthetic joint infections due to Enterococcus sp. and predictors of failure: a multi-national study. Clin Microbiol Infect. 2014;20(11):1219–24.

Choi HR, von Knoch F, Kandil AO. et al. Retention treatment after periprosthetic total hip arthroplasty infection. Int Orthop. 2012;36(4):723–9. [PMC free article]