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Should we expand the indications for the DAIR (debridement, antibiotic therapy, and implant retention) procedure for Staphylococcus aureus prosthetic joint infections? A multicenter retrospective study.
Eur J Clin Microbiol Infect Dis 2018; 37(10):1949-1956EJ

Abstract

To evaluate factors associated with failure in patients treated with DAIR (debridement, antibiotic therapy, and implant retention) for Staphylococcus aureus prosthetic joint infections (PJIs). We retrospectively analyzed consecutive patients with stable PJI due to S. aureus treated with DAIR at six hospitals between 2010 and 2014. Cox proportional hazards regression was used to study factors associated with treatment failure at 2 years. Of 154 eligible patients, 137 were included (mean age 73 ± 13 years; male 56%). The estimated success rate according to the Kaplan-Meier method was 76.2 [95% CI 68-83] at 2 years of follow-up. In multivariate analysis, longer duration of treatment (hazard ratio (HR) 0.78 [0.69-0.88]; p < 0.001) and combination therapy including rifampin (HR 0.08 [0.018-0.36]; p = 0.001) were independently associated with success, whereas active smoking was independently associated with failure (HR 3.6 [1.09-11.84]; p = 0.036). When the analysis was restricted to patients with early infection onset (< 3 months), early acute infection was also predictive of a better prognosis (HR 0.25 [0.09-0.7]; p = 0.009). Failure was not associated with time from prosthesis insertion to debridement, nor with duration of symptoms > 3 weeks and type of prosthesis (hip or knee). These results remained unchanged when the 14 patients under immunosuppressive therapy were removed from analysis. These data suggest that DAIR can be performed even if infection and symptoms are delayed but reserved to patients who are able to follow rifampin-based combination therapy for a prolonged duration that should not be different for hip and knee PJI.

Authors+Show Affiliations

Service des Maladies Infectieuses et Tropicales, Hôpital Gabriel Montpied, CRIOAc, CHU, Clermont-Ferrand, France. olesens@chu-clermontferrand.fr. Laboratoire Microorganismes: Génome Environnement (LMGE) UMR 6023, Université Clermont Auvergne, Clermont-Ferrand, France. olesens@chu-clermontferrand.fr.Hospices Civils de Lyon, CRIOAc Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France.Service de Maladies Infectieuses, CH Métropole Savoie, Chambéry, France.Service d'Infectiologie, CIC1408-Inserm, CRIOAc Saint-Etienne, Hôpital Nord-CHU Saint Etienne, 42055, Saint-Etienne, France.Service de Maladies Infectieuses, CHU Grenoble Alpes, Grenoble, France.Service d'Infectiologie, CH Annecy Genevois, 74000, Annecy, France.CHU Clermont-Ferrand, DRCI-Biostatistique, Clermont-Ferrand, France.Service d'Orthopédie-Traumatologie, CH Metropole Savoie, Chambéry, France.Service Orthopédie, CRIOAc Saint-Etienne, Hôpital Nord-CHU Saint-Etienne, Saint-Etienne, France.Hospices Civils de Lyon, CRIOAc Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France.Université Clermont- Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000, Clermont-Ferrand, France. Institut de Chimie de Clermont-Ferrand (ICCF), UMR 6296, 24, avenue Blaise-Pascal, 63178, Aubiere, France.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

30083889

Citation

Lesens, O, et al. "Should We Expand the Indications for the DAIR (debridement, Antibiotic Therapy, and Implant Retention) Procedure for Staphylococcus Aureus Prosthetic Joint Infections? a Multicenter Retrospective Study." European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology, vol. 37, no. 10, 2018, pp. 1949-1956.
Lesens O, Ferry T, Forestier E, et al. Should we expand the indications for the DAIR (debridement, antibiotic therapy, and implant retention) procedure for Staphylococcus aureus prosthetic joint infections? A multicenter retrospective study. Eur J Clin Microbiol Infect Dis. 2018;37(10):1949-1956.
Lesens, O., Ferry, T., Forestier, E., Botelho-Nevers, E., Pavese, P., Piet, E., ... Descamps, S. (2018). Should we expand the indications for the DAIR (debridement, antibiotic therapy, and implant retention) procedure for Staphylococcus aureus prosthetic joint infections? A multicenter retrospective study. European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology, 37(10), pp. 1949-1956. doi:10.1007/s10096-018-3330-7.
Lesens O, et al. Should We Expand the Indications for the DAIR (debridement, Antibiotic Therapy, and Implant Retention) Procedure for Staphylococcus Aureus Prosthetic Joint Infections? a Multicenter Retrospective Study. Eur J Clin Microbiol Infect Dis. 2018;37(10):1949-1956. PubMed PMID: 30083889.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Should we expand the indications for the DAIR (debridement, antibiotic therapy, and implant retention) procedure for Staphylococcus aureus prosthetic joint infections? A multicenter retrospective study. AU - Lesens,O, AU - Ferry,T, AU - Forestier,E, AU - Botelho-Nevers,E, AU - Pavese,P, AU - Piet,E, AU - Pereira,B, AU - Montbarbon,E, AU - Boyer,B, AU - Lustig,S, AU - Descamps,S, AU - ,, Y1 - 2018/08/07/ PY - 2018/02/16/received PY - 2018/07/16/accepted PY - 2018/8/8/pubmed PY - 2018/8/8/medline PY - 2018/8/8/entrez KW - Biofilm KW - DAIR procedure (debridement, antibiotic therapy, and implant retention) KW - Lavage KW - Prosthetic joint infection KW - Rifampin KW - Staphylococcus aureus SP - 1949 EP - 1956 JF - European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology JO - Eur. J. Clin. Microbiol. Infect. Dis. VL - 37 IS - 10 N2 - To evaluate factors associated with failure in patients treated with DAIR (debridement, antibiotic therapy, and implant retention) for Staphylococcus aureus prosthetic joint infections (PJIs). We retrospectively analyzed consecutive patients with stable PJI due to S. aureus treated with DAIR at six hospitals between 2010 and 2014. Cox proportional hazards regression was used to study factors associated with treatment failure at 2 years. Of 154 eligible patients, 137 were included (mean age 73 ± 13 years; male 56%). The estimated success rate according to the Kaplan-Meier method was 76.2 [95% CI 68-83] at 2 years of follow-up. In multivariate analysis, longer duration of treatment (hazard ratio (HR) 0.78 [0.69-0.88]; p < 0.001) and combination therapy including rifampin (HR 0.08 [0.018-0.36]; p = 0.001) were independently associated with success, whereas active smoking was independently associated with failure (HR 3.6 [1.09-11.84]; p = 0.036). When the analysis was restricted to patients with early infection onset (< 3 months), early acute infection was also predictive of a better prognosis (HR 0.25 [0.09-0.7]; p = 0.009). Failure was not associated with time from prosthesis insertion to debridement, nor with duration of symptoms > 3 weeks and type of prosthesis (hip or knee). These results remained unchanged when the 14 patients under immunosuppressive therapy were removed from analysis. These data suggest that DAIR can be performed even if infection and symptoms are delayed but reserved to patients who are able to follow rifampin-based combination therapy for a prolonged duration that should not be different for hip and knee PJI. SN - 1435-4373 UR - https://www.unboundmedicine.com/medline/citation/30083889/Should_we_expand_the_indications_for_the_DAIR__debridement_antibiotic_therapy_and_implant_retention__procedure_for_Staphylococcus_aureus_prosthetic_joint_infections_A_multicenter_retrospective_study_ L2 - https://dx.doi.org/10.1007/s10096-018-3330-7 DB - PRIME DP - Unbound Medicine ER -