Marjan Wouthuyzen-Bakker1, Marine Sebillotte2, Kaisa Huotari3, Rosa Escudero Sánchez4, Eva Benavent5, Javad Parvizi6, Marta Fernandez-Sampedro7, José Maria Barbero8, Joaquín Garcia-Cañete9, Rihard Trebse10, Maria Del Toro11, Vicens Diaz-Brito12, Marisa Sanchez13, Matthew Scarborough14, Alex Soriano15. 1. M. Wouthuyzen-Bakker, Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, the Netherlands. 2. M. Sebillotte, Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France. 3. K. Huotari, Inflammation center, Infectious Diseases, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Finland. 4. R. Escudero-Sánchez, Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain. 5. E. Benavent, Infectious Disease Service, IDIBELL-Hospital Universitari Bellvitge, Barcelona, Spain. 6. J. Parvizi, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA. 7. M. Fernandez-Sampedro, Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marques de Valdecilla-IDIVAL, Cantabria, Spain. 8. J. M. Barbero, Department of Internal Medicine, Hospital Universitario Principe de Asturias, Madrid, Spain. 9. J. Garcia-Cañete, Department of Internal Medicine-Emergency, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain. 10. R. Trebse, Service for Bone Infections, Valdoltra Orthopaedic Hospital, Ankaran, Slovenia. 11. M. Del Toro, Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain. 12. V. Diaz-Brito, Infectious Diseases Unit, Parc Sanitari Sant Joan de Deu, Sant Boi, Barcelona, Spain. 13. M. Sanchez, Infectious Diseases Section, Internal Medicine Service, Hospital Italiano de Buenos Aires, Argentina. 14. M. Scarborough, Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, England. 15. A. Soriano, Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain.
Abstract
BACKGROUND: Surgical débridement, antibiotics and implant retention (DAIR) is currently recommended by international guidelines for both early acute (postsurgical) and late acute (hematogenous) periprosthetic joint infections (PJIs). However, due to a different pathogenesis of infection, a different treatment strategy may be needed. QUESTIONS/PURPOSES: (1) Compared with early acute PJIs, are late acute PJIs associated with a higher risk of DAIR failure? (2) When stratified by microorganism, is the higher risk of failure in late acute PJI associated with Staphylocococcus aureus infection? (3) When analyzing patients with S. aureus infection, what factors are independently associated with DAIR failure? METHODS: In this multicenter observational study, early acute and late acute PJIs treated with DAIR were retrospectively evaluated and matched according to treating center, year of diagnosis, and infection-causing microorganism. If multiple matches were available, the early acute PJI diagnosed closest to the late acute PJI was selected. A total of 132 pairs were included. Treatment success was defined as a retained implant during follow-up without the need for antibiotic suppressive therapy. RESULTS: Late acute PJIs had a lower treatment success (46% [60 of 132]) compared with early acute PJIs (76% [100 of 132]), OR 3.9 [95% CI 2.3 to 6.6]; p < 0.001), but the lower treatment success of late acute PJIs was only observed when caused by Staphylococcus spp (S. aureus: 34% versus 75%; p < 0.001; coagulase-negative staphylococci: 46% versus 88%; p = 0.013, respectively). On multivariable analysis, late acute PJI was the only independent factor associated with an unsuccessful DAIR when caused by S. aureus (OR 4.52 [95% CI 1.79 to 11.41]; p < 0.001). CONCLUSIONS: Although DAIR seems to be a successful therapeutic strategy in the management of early acute PJI, its use in late acute PJI should be reconsidered when caused by Staphylococcus spp. Our results advocate the importance of isolating the causative microorganism before surgery. LEVEL OF EVIDENCE: Level III, therapeutic study.
BACKGROUND: Surgical débridement, antibiotics and implant retention (DAIR) is currently recommended by international guidelines for both early acute (postsurgical) and late acute (hematogenous) periprosthetic joint infections (PJIs). However, due to a different pathogenesis of infection, a different treatment strategy may be needed. QUESTIONS/PURPOSES: (1) Compared with early acute PJIs, are late acute PJIs associated with a higher risk of DAIR failure? (2) When stratified by microorganism, is the higher risk of failure in late acute PJI associated with Staphylocococcus aureus infection? (3) When analyzing patients with S. aureus infection, what factors are independently associated with DAIR failure? METHODS: In this multicenter observational study, early acute and late acute PJIs treated with DAIR were retrospectively evaluated and matched according to treating center, year of diagnosis, and infection-causing microorganism. If multiple matches were available, the early acute PJI diagnosed closest to the late acute PJI was selected. A total of 132 pairs were included. Treatment success was defined as a retained implant during follow-up without the need for antibiotic suppressive therapy. RESULTS: Late acute PJIs had a lower treatment success (46% [60 of 132]) compared with early acute PJIs (76% [100 of 132]), OR 3.9 [95% CI 2.3 to 6.6]; p < 0.001), but the lower treatment success of late acute PJIs was only observed when caused by Staphylococcus spp (S. aureus: 34% versus 75%; p < 0.001; coagulase-negative staphylococci: 46% versus 88%; p = 0.013, respectively). On multivariable analysis, late acute PJI was the only independent factor associated with an unsuccessful DAIR when caused by S. aureus (OR 4.52 [95% CI 1.79 to 11.41]; p < 0.001). CONCLUSIONS: Although DAIR seems to be a successful therapeutic strategy in the management of early acute PJI, its use in late acute PJI should be reconsidered when caused by Staphylococcus spp. Our results advocate the importance of isolating the causative microorganism before surgery. LEVEL OF EVIDENCE: Level III, therapeutic study.
Authors: Jean Noël Argenson; Marius Arndt; George Babis; Andrew Battenberg; Nicolaas Budhiparama; Fabio Catani; Foster Chen; Brian de Beaubien; Ayman Ebied; Silvano Esposito; Christopher Ferry; Henry Flores; Andrea Giorgini; Erik Hansen; K D Hernugrahanto; Choe Hyonmin; Tae-Kyun Kim; In Jun Koh; Georgios Komnos; Christian Lausmann; Jeremy Loloi; Jaime Lora-Tamayo; I Lumban-Gaol; F Mahyudin; Mikel Mancheno-Losa; Camelia Marculescu; Sameh Marei; Kimberly E Martin; Prashant Meshram; Wayne G Paprosky; Lazaros Poultsides; Arjun Saxena; Evan Schwechter; Jay Shah; Noam Shohat; Rafael J Sierra; Alex Soriano; Anna Stefánsdóttir; Linda I Suleiman; Adrian Taylor; Georgios K Triantafyllopoulos; Dwikora Novembri Utomo; David Warren; Leo Whiteside; Marjan Wouthuyzen-Bakker; Jean Yombi; Benjamin Zmistowski Journal: J Arthroplasty Date: 2018-10-19 Impact factor: 4.757
Authors: Marjan Wouthuyzen-Bakker; Marine Sebillotte; Jose Lomas; Adrian Taylor; Eva Benavent Palomares; Oscar Murillo; Javad Parvizi; Noam Shohat; Javier Cobo Reinoso; Rosa Escudero Sánchez; Marta Fernandez-Sampedro; Eric Senneville; Kaisa Huotari; José Maria Barbero; Joaquín Garcia-Cañete; Jaime Lora-Tamayo; Matteo Carlo Ferrari; Danguole Vaznaisiene; Erlangga Yusuf; Craig Aboltins; Rihard Trebse; Mauro José Salles; Natividad Benito; Andrea Vila; Maria Dolores Del Toro; Tobias Siegfried Kramer; Sabine Petersdorf; Vicens Diaz-Brito; Zeliha Kocak Tufan; Marisa Sanchez; Cédric Arvieux; Alex Soriano Journal: J Infect Date: 2018-08-07 Impact factor: 6.072
Authors: Andrés F Duque; Zachary D Post; Rex W Lutz; Fabio R Orozco; Sergio H Pulido; Alvin C Ong Journal: J Arthroplasty Date: 2016-11-01 Impact factor: 4.757
Authors: Ho-Rim Choi; Fabian von Knoch; David Zurakowski; Sandra B Nelson; Henrik Malchau Journal: Clin Orthop Relat Res Date: 2011-04 Impact factor: 4.176
Authors: F Ruben H A Nurmohamed; Bruce van Dijk; Ewout S Veltman; Marrit Hoekstra; Rob J Rentenaar; Harrie H Weinans; H Charles Vogely; Bart C H van der Wal Journal: J Bone Jt Infect Date: 2021-01-27
Authors: H Scheper; L M Gerritsen; B G Pijls; S A Van Asten; L G Visser; M G J De Boer Journal: Open Forum Infect Dis Date: 2021-07-01 Impact factor: 3.835
Authors: Ewout S Veltman; Erik Lenguerrand; Dirk Jan F Moojen; Michael R Whitehouse; Rob G H H Nelissen; Ashley W Blom; Rudolf W Poolman Journal: Acta Orthop Date: 2020-07-23 Impact factor: 3.717