Debridement, Antibiotics, and Implant Retention Is a Viable Treatment Option for Early Periprosthetic Joint Infection Presenting More Than 4 Weeks After Index Arthroplasty.
| Autor: | Löwik, Claudia A M, Parvizi, Javad, Jutte, Paul C, Zijlstra, Wierd P, Knobben, Bas A S, Xu, Chi, Goswami, Karan, Belden, Katherine A, Sousa, Ricardo, Carvalho, André, Martínez-Pastor, Juan Carlos, Soriano, Alex, Wouthuyzen-Bakker, Marjan |
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| Předmět: |
ANTIBIOTICS
ANALYSIS of variance ARTHROPLASTY ARTIFICIAL joints CHI-squared test CONFIDENCE intervals DEBRIDEMENT INFECTION MEDICAL cooperation PROSTHETICS COMPLICATIONS of prosthesis RESEARCH STATISTICS T-test (Statistics) TIME LOGISTIC regression analysis RETROSPECTIVE studies DATA analysis software DESCRIPTIVE statistics ODDS ratio MANN Whitney U Test |
| Zdroj: | Clinical Infectious Diseases; 8/1/2020, Vol. 71 Issue 3, p630-636, 7p |
| Abstrakt: | Background The success of debridement, antibiotics, and implant retention (DAIR) in early periprosthetic joint infection (PJI) largely depends on the presence of a mature biofilm. At what time point DAIR should be disrecommended is unknown. This multicenter study evaluated the outcome of DAIR in relation to the time after index arthroplasty. Methods We retrospectively evaluated PJIs occurring within 90 days after surgery and treated with DAIR. Patients with bacteremia, arthroscopic debridements, and a follow-up <1 year were excluded. Treatment failure was defined as (1) any further surgical procedure related to infection; (2) PJI-related death; or (3) use of long-term suppressive antibiotics. Results We included 769 patients. Treatment failure occurred in 294 patients (38%) and was similar between time intervals from index arthroplasty to DAIR: the failure rate for Week 1–2 was 42% (95/226), the rate for Week 3–4 was 38% (143/378), the rate for Week 5–6 was 29% (29/100), and the rate for Week 7–12 was 42% (27/65). An exchange of modular components was performed to a lesser extent in the early post-surgical course compared with the late course (41% vs 63%, respectively; P <.001). The causative microorganisms, comorbidities, and durations of symptoms were comparable between time intervals. Conclusions DAIR is a viable option in patients with early PJI presenting more than 4 weeks after index surgery, as long as DAIR is performed within at least 1 week after the onset of symptoms and modular components can be exchanged. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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