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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):380-6AO

Abstract

BACKGROUND AND PURPOSE

For prosthetic joint-associated infection (PJI), a regimen of debridement, antibiotics, irrigation, and retention of the prosthesis (DAIR) is generally accepted for acute infections. Various risk factors associated with treatment success have been described. The use of local antibiotic carriers (beads and sponges) is relatively unknown. We retrospectively analyzed risk factors in a cohort of patients from 3 hospitals, treated with DAIR for PJI.

PATIENTS AND METHODS

91 patients treated with DAIR for hip or knee PJI in 3 Dutch centers between 2004 and 2009 were retrospectively evaluated. The mean follow-up was 3 years. Treatment success was defined as absence of infection after 2 years, with retention of the prosthesis and without the use of suppressive antibiotics.

RESULTS

60 patients (66%) were free of infection at follow-up. Factors associated with treatment failure were: a history of rheumatoid arthritis, late infection (> 2 years after arthroplasty), ESR at presentation above 60 mm/h, and infection caused by coagulase-negative Staphylococcus. Symptom duration of less than 1 week was associated with treatment success. The use of gentamicin sponges was statistically significantly higher in the success group, and the use of beads was higher in the failure group in the univariate analysis, but these differences did not reach significance in the logistic regression analysis. Less surgical procedures were performed in the group treated with sponges than in the group treated with beads.

INTERPRETATION

In the presence of rheumatoid arthritis, duration of symptoms of more than 1 week, ESR above 60 mm/h, late infection (> 2 years after arthroplasty), and coagulase-negative Staphylococcus PJI, the chances of successful DAIR treatment decrease, and other treatment methods should be considered.

Authors+Show Affiliations

Department of Orthopedic Surgery, Medical Center Alkmaar, Alkmaar, the Netherlands. jwp.kuiper@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23848215

Citation

Kuiper, Jesse W P., 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 Orthopaedica, vol. 84, no. 4, 2013, pp. 380-6.
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.
Kuiper, J. W., Vos, S. J., Saouti, R., Vergroesen, D. A., Graat, H. C., Debets-Ossenkopp, Y. J., ... Nolte, P. A. (2013). Prosthetic joint-associated infections treated with DAIR (debridement, antibiotics, irrigation, and retention): analysis of risk factors and local antibiotic carriers in 91 patients. Acta Orthopaedica, 84(4), pp. 380-6. doi:10.3109/17453674.2013.823589.
Kuiper JW, 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. PubMed PMID: 23848215.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prosthetic joint-associated infections treated with DAIR (debridement, antibiotics, irrigation, and retention): analysis of risk factors and local antibiotic carriers in 91 patients. AU - Kuiper,Jesse W P, AU - Vos,Stan J Cj, AU - Saouti,Rachid, AU - Vergroesen,Diederik A, AU - Graat,Harm C A, AU - Debets-Ossenkopp,Yvette J, AU - Peters,Edgar J G, AU - Nolte,Peter A, Y1 - 2013/07/12/ PY - 2013/7/16/entrez PY - 2013/7/16/pubmed PY - 2013/12/16/medline SP - 380 EP - 6 JF - Acta orthopaedica JO - Acta Orthop VL - 84 IS - 4 N2 - BACKGROUND AND PURPOSE: For prosthetic joint-associated infection (PJI), a regimen of debridement, antibiotics, irrigation, and retention of the prosthesis (DAIR) is generally accepted for acute infections. Various risk factors associated with treatment success have been described. The use of local antibiotic carriers (beads and sponges) is relatively unknown. We retrospectively analyzed risk factors in a cohort of patients from 3 hospitals, treated with DAIR for PJI. PATIENTS AND METHODS: 91 patients treated with DAIR for hip or knee PJI in 3 Dutch centers between 2004 and 2009 were retrospectively evaluated. The mean follow-up was 3 years. Treatment success was defined as absence of infection after 2 years, with retention of the prosthesis and without the use of suppressive antibiotics. RESULTS: 60 patients (66%) were free of infection at follow-up. Factors associated with treatment failure were: a history of rheumatoid arthritis, late infection (> 2 years after arthroplasty), ESR at presentation above 60 mm/h, and infection caused by coagulase-negative Staphylococcus. Symptom duration of less than 1 week was associated with treatment success. The use of gentamicin sponges was statistically significantly higher in the success group, and the use of beads was higher in the failure group in the univariate analysis, but these differences did not reach significance in the logistic regression analysis. Less surgical procedures were performed in the group treated with sponges than in the group treated with beads. INTERPRETATION: In the presence of rheumatoid arthritis, duration of symptoms of more than 1 week, ESR above 60 mm/h, late infection (> 2 years after arthroplasty), and coagulase-negative Staphylococcus PJI, the chances of successful DAIR treatment decrease, and other treatment methods should be considered. SN - 1745-3682 UR - https://www.unboundmedicine.com/medline/citation/23848215/Prosthetic_joint_associated_infections_treated_with_DAIR__debridement_antibiotics_irrigation_and_retention_:_analysis_of_risk_factors_and_local_antibiotic_carriers_in_91_patients_ L2 - http://www.tandfonline.com/doi/full/10.3109/17453674.2013.823589 DB - PRIME DP - Unbound Medicine ER -