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Predicting Failure in Early Acute Prosthetic Joint Infection Treated With Debridement, Antibiotics, and Implant Retention: External Validation of the KLIC Score.
J Arthroplasty 2018; 33(8):2582-2587JA

Abstract

BACKGROUND

Debridement, antibiotics, and implant retention (DAIR) is a widely used treatment modality for early acute prosthetic joint infection (PJI). A preoperative risk score was previously designed for predicting DAIR failure, consisting of chronic renal failure (K), liver cirrhosis (L), index surgery (I), cemented prosthesis (C), and C-reactive protein >115 mg/L (KLIC). The aim of this study was to validate the KLIC score in an external cohort.

METHODS

We retrospectively evaluated patients with early acute PJI treated with DAIR between 2006 and 2016 in 3 Dutch hospitals. Early acute PJI was defined as <21 days of symptoms and DAIR performed within 90 days after index surgery. Failure was defined as the need for (1) second DAIR, (2) implant removal, (3) suppressive antimicrobial treatment, or (4) infection-related death within 60 days after debridement.

RESULTS

A total of 386 patients were included. Failure occurred in 148 patients (38.3%). Patients with KLIC scores of ≤2, 2.5-3.5, 4-5, 5.5-6.5, and ≥7 had failure rates of 27.9%, 37.1%, 49.3%, 54.5%, and 85.7%, respectively (P < .001). The receiver-operating characteristic curve showed an area under the curve of 0.64 (95% confidence interval 0.59-0.69). A KLIC score higher than 6 points showed a specificity of 97.9%.

CONCLUSION

The KLIC score is a relatively good preoperative risk score for DAIR failure in patients with early acute PJI and appears to be most useful in clinical practice for patients with low or high KLIC scores.

Authors+Show Affiliations

Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Department of Orthopaedic Surgery, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands.Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands.Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.Department of Infectious Diseases, University of Barcelona, Hospital Clinic of Barcelona, Barcelona, Spain.Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.No affiliation info available

Pub Type(s)

Journal Article
Validation Studies

Language

eng

PubMed ID

29691168

Citation

Löwik, Claudia A M., et al. "Predicting Failure in Early Acute Prosthetic Joint Infection Treated With Debridement, Antibiotics, and Implant Retention: External Validation of the KLIC Score." The Journal of Arthroplasty, vol. 33, no. 8, 2018, pp. 2582-2587.
Löwik CAM, Jutte PC, Tornero E, et al. Predicting Failure in Early Acute Prosthetic Joint Infection Treated With Debridement, Antibiotics, and Implant Retention: External Validation of the KLIC Score. J Arthroplasty. 2018;33(8):2582-2587.
Löwik, C. A. M., Jutte, P. C., Tornero, E., Ploegmakers, J. J. W., Knobben, B. A. S., de Vries, A. J., ... Wouthuyzen-Bakker, M. (2018). Predicting Failure in Early Acute Prosthetic Joint Infection Treated With Debridement, Antibiotics, and Implant Retention: External Validation of the KLIC Score. The Journal of Arthroplasty, 33(8), pp. 2582-2587. doi:10.1016/j.arth.2018.03.041.
Löwik CAM, et al. Predicting Failure in Early Acute Prosthetic Joint Infection Treated With Debridement, Antibiotics, and Implant Retention: External Validation of the KLIC Score. J Arthroplasty. 2018;33(8):2582-2587. PubMed PMID: 29691168.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicting Failure in Early Acute Prosthetic Joint Infection Treated With Debridement, Antibiotics, and Implant Retention: External Validation of the KLIC Score. AU - Löwik,Claudia A M, AU - Jutte,Paul C, AU - Tornero,Eduard, AU - Ploegmakers,Joris J W, AU - Knobben,Bas A S, AU - de Vries,Astrid J, AU - Zijlstra,Wierd P, AU - Dijkstra,Baukje, AU - Soriano,Alex, AU - Wouthuyzen-Bakker,Marjan, AU - ,, Y1 - 2018/03/27/ PY - 2018/01/09/received PY - 2018/02/16/revised PY - 2018/03/17/accepted PY - 2018/4/25/pubmed PY - 2019/3/6/medline PY - 2018/4/26/entrez KW - DAIR KW - external validation KW - joint arthroplasty KW - prosthetic joint infection KW - risk score SP - 2582 EP - 2587 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 33 IS - 8 N2 - BACKGROUND: Debridement, antibiotics, and implant retention (DAIR) is a widely used treatment modality for early acute prosthetic joint infection (PJI). A preoperative risk score was previously designed for predicting DAIR failure, consisting of chronic renal failure (K), liver cirrhosis (L), index surgery (I), cemented prosthesis (C), and C-reactive protein >115 mg/L (KLIC). The aim of this study was to validate the KLIC score in an external cohort. METHODS: We retrospectively evaluated patients with early acute PJI treated with DAIR between 2006 and 2016 in 3 Dutch hospitals. Early acute PJI was defined as <21 days of symptoms and DAIR performed within 90 days after index surgery. Failure was defined as the need for (1) second DAIR, (2) implant removal, (3) suppressive antimicrobial treatment, or (4) infection-related death within 60 days after debridement. RESULTS: A total of 386 patients were included. Failure occurred in 148 patients (38.3%). Patients with KLIC scores of ≤2, 2.5-3.5, 4-5, 5.5-6.5, and ≥7 had failure rates of 27.9%, 37.1%, 49.3%, 54.5%, and 85.7%, respectively (P < .001). The receiver-operating characteristic curve showed an area under the curve of 0.64 (95% confidence interval 0.59-0.69). A KLIC score higher than 6 points showed a specificity of 97.9%. CONCLUSION: The KLIC score is a relatively good preoperative risk score for DAIR failure in patients with early acute PJI and appears to be most useful in clinical practice for patients with low or high KLIC scores. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/29691168/Predicting_Failure_in_Early_Acute_Prosthetic_Joint_Infection_Treated_With_Debridement_Antibiotics_and_Implant_Retention:_External_Validation_of_the_KLIC_Score_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(18)30299-7 DB - PRIME DP - Unbound Medicine ER -