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Debridement, antibiotics and implant retention in early periprosthetic joint infection.
Hip Int 2016 Mar-Apr; 26(2):138-43HI

Abstract

INTRODUCTION

Periprosthetic joint infection (PJI) is a devastating complication in hip arthroplasty surgery. Debridement, antibiotics (AB) and implant retention (DAIR) is recommended in early PJI in association with stable implants. The aim of this study was to evaluate the success rate of DAIR in early PJI (<4 weeks) and to identify factors predicting the outcome.

METHODS

This cohort study included a consecutive series of 35 patients (median age 74 years, 25 women, 26 primary arthroplasties) treated with DAIR for an early PJI in a regional hospital.

RESULTS

28 patients (80%) had their infection eradicated. DAIR-only eradicated the PJI in 22 (63%) patients with a median follow-up of 50 (24-84) months. In 17 (49%) patients, oral AB had been given prior to intraoperative cultures, which delayed first debridement with average 6 days and delayed hospital stay. Primary surgery for a hip fracture increased the risk of DAIR-failure. Surgical experience did not affect the outcome. 17% (n = 6) of the patients sustained a secondary infection during their hospital stay; the majority was beta-lactam resistant coagulase negative Staphylococcus aureus.

CONCLUSIONS

The success rate of DAIR was inferior to pervious controls from experienced revision centers. Hip fracture patients should be informed about the increased risk of DAIR treatment failure. In order not to delay surgery, empirically based oral AB should not be administered prior to deep cultures.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02087020.

Authors+Show Affiliations

Department of Orthopaedics at Danderyd Hospital and Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm - Sweden.Department of Surgical and Perioperative Sciences, Umeå University, Umeå - Sweden.Department of Infectious Diseases, Karolinska University Hospital, Stockholm - Sweden.Department of Orthopaedics at Danderyd Hospital and Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm - Sweden.Department of Surgical and Perioperative Sciences, Umeå University, Umeå - Sweden.Department of Orthopaedics at Danderyd Hospital and Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm - Sweden.Department of Orthopaedics at Danderyd Hospital and Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm - Sweden.

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26868114

Citation

Bergkvist, Magnus, et al. "Debridement, Antibiotics and Implant Retention in Early Periprosthetic Joint Infection." Hip International : the Journal of Clinical and Experimental Research On Hip Pathology and Therapy, vol. 26, no. 2, 2016, pp. 138-43.
Bergkvist M, Mukka SS, Johansson L, et al. Debridement, antibiotics and implant retention in early periprosthetic joint infection. Hip Int. 2016;26(2):138-43.
Bergkvist, M., Mukka, S. S., Johansson, L., Ahl, T. E., Sayed-Noor, A. S., Sköldenberg, O. G., & Eisler, T. (2016). Debridement, antibiotics and implant retention in early periprosthetic joint infection. Hip International : the Journal of Clinical and Experimental Research On Hip Pathology and Therapy, 26(2), pp. 138-43. doi:10.5301/hipint.5000328.
Bergkvist M, et al. Debridement, Antibiotics and Implant Retention in Early Periprosthetic Joint Infection. Hip Int. 2016;26(2):138-43. PubMed PMID: 26868114.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Debridement, antibiotics and implant retention in early periprosthetic joint infection. AU - Bergkvist,Magnus, AU - Mukka,Sebastian S, AU - Johansson,Lars, AU - Ahl,Torbjörn E, AU - Sayed-Noor,Arkan S, AU - Sköldenberg,Olof G, AU - Eisler,Thomas, Y1 - 2016/02/08/ PY - 2015/10/20/accepted PY - 2016/2/13/entrez PY - 2016/2/13/pubmed PY - 2017/1/10/medline SP - 138 EP - 43 JF - Hip international : the journal of clinical and experimental research on hip pathology and therapy JO - Hip Int VL - 26 IS - 2 N2 - INTRODUCTION: Periprosthetic joint infection (PJI) is a devastating complication in hip arthroplasty surgery. Debridement, antibiotics (AB) and implant retention (DAIR) is recommended in early PJI in association with stable implants. The aim of this study was to evaluate the success rate of DAIR in early PJI (<4 weeks) and to identify factors predicting the outcome. METHODS: This cohort study included a consecutive series of 35 patients (median age 74 years, 25 women, 26 primary arthroplasties) treated with DAIR for an early PJI in a regional hospital. RESULTS: 28 patients (80%) had their infection eradicated. DAIR-only eradicated the PJI in 22 (63%) patients with a median follow-up of 50 (24-84) months. In 17 (49%) patients, oral AB had been given prior to intraoperative cultures, which delayed first debridement with average 6 days and delayed hospital stay. Primary surgery for a hip fracture increased the risk of DAIR-failure. Surgical experience did not affect the outcome. 17% (n = 6) of the patients sustained a secondary infection during their hospital stay; the majority was beta-lactam resistant coagulase negative Staphylococcus aureus. CONCLUSIONS: The success rate of DAIR was inferior to pervious controls from experienced revision centers. Hip fracture patients should be informed about the increased risk of DAIR treatment failure. In order not to delay surgery, empirically based oral AB should not be administered prior to deep cultures. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02087020. SN - 1724-6067 UR - https://www.unboundmedicine.com/medline/citation/26868114/Debridement_antibiotics_and_implant_retention_in_early_periprosthetic_joint_infection_ L2 - http://journals.sagepub.com/doi/full/10.5301/hipint.5000328?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -