Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention - 28/12/18
, Marine Sebillotte b, Jose Lomas c, Adrian Taylor c, Eva Benavent Palomares d, Oscar Murillo d, Javad Parvizi e, Noam Shohat e, f, Javier Cobo Reinoso g, Rosa Escudero Sánchez g, Marta Fernandez-Sampedro h, Eric Senneville i, Kaisa Huotari j, José Maria Barbero k, Joaquín Garcia-Cañete l, Jaime Lora-Tamayo m, Matteo Carlo Ferrari n, Danguole Vaznaisiene o, Erlangga Yusuf p, Craig Aboltins q, r, Rihard Trebse s, Mauro José Salles t, Natividad Benito u, Andrea Vila v, Maria Dolores Del Toro w, Tobias Siegfried Kramer x, y, Sabine Petersdorf z, Vicens Diaz-Brito aa, Zeliha Kocak Tufan bb, Marisa Sanchez cc, Cédric Arvieux b, dd, Alex Soriano eeon behalf of the
ESCMID Study Group for Implant-Associated Infections (ESGIAI)
Highlights |
• | Late acute prosthetic joint infection (PJI) treated with surgical debridement and implant retention have a high failure rate. |
• | The exchange of mobile components during surgical debridement is the most potent predictor for treatment success. |
• | There are several preoperative patient related variables that increase the risk for failure. |
• | Treatment strategies for late acute PJIs should be individualized and optimized according to the preoperative risk for failing. |
Summary |
Objectives |
Debridement, antibiotics and implant retention (DAIR) is the recommended treatment for all acute prosthetic joint infections (PJI), but its efficacy in patients with late acute (LA) PJI is not well described.
Methods |
Patients diagnosed with LA PJI between 2005 and 2015 were retrospectively evaluated. LA PJI was defined as the development of acute symptoms (≤ 3 weeks) occurring ≥ 3 months after arthroplasty. Failure was defined as: (i) the need for implant removal, (ii) infection related death, (iii) the need for suppressive antibiotic therapy and/or (iv) relapse or reinfection during follow-up.
Results |
340 patients from 27 centers were included. The overall failure rate was 45.0% (153/340). Failure was dominated by Staphylococcus aureus PJI (54.7%, 76/139). Significant independent preoperative risk factors for failure according to the multivariate analysis were: fracture as indication for the prosthesis (odds ratio (OR) 5.4), rheumatoid arthritis (OR 5.1), age above 80 years (OR 2.6), male gender (OR 2.0) and C-reactive protein > 150 mg/L (OR 2.0). Exchanging the mobile components during DAIR was the strongest predictor for treatment success (OR 0.35).
Conclusion |
LA PJIs have a high failure rate. Treatment strategies should be individualized according to patients’ age, comorbidity, clinical presentation and microorganism causing the infection.
Le texte complet de cet article est disponible en PDF.Keywords : Prosthetic joint infection, Acute, Hematogenous, Risk factors, failure
Plan
| ☆ | Collaborators: Anne Gougeon, Harold Common, Anne Méheut, Joan Gomez-Junyent, Majd Tarabichi, Aybegum Demirturk, Taiana Ribeiro, Emerson Honda, Giancarlo Polesello, Paul Jutte, Joris Ploegmakers, Claudia Löwik, Guillem Bori, Laura Morata, Luis Lozano, Antonio Blanco García, Mikel Mancheño, Fernando Chaves, David Smolders, Phongsakone Inthavong, Marc Digumber, Bernadette Genevieve Pfang, Eduard Tornero, Encarna Moreno, Ulrich Nöth, Cynthia Rivero, Pere Coll, Xavier Crusi, Isabel Mur, Juan Dapás, Pierre Tattevin, Jaime Esteban, Matthew Scarborough. |
Vol 78 - N° 1
P. 40-47 - janvier 2019 Retour au numéro
Article précédent
- Outcomes of patients with drug-resistant-tuberculosis treated with bedaquiline-containing regimens and undergoing adjunctive surgery
- Sergey E. Borisov, Lia D'Ambrosio, Rosella Centis, Simon Tiberi, Keertan Dheda, Jan-Willem Alffenaar, Rohit Amale, Evgeny Belilowski, Judith Bruchfeld, Barbara Canneto, Justin Denholm, Raquel Duarte, Aliasgar Esmail, Alex Filippov, Lina Davies Forsman, Mina Gaga, Shashank Ganatra, Gaida Anastasia Igorevna, Barbara Lazaro Mastrapa, Vinicio Manfrin, Selene Manga, Andrey Maryandyshev, Gilbert Massard, Pablo González Montaner, Jai Mullerpattan, Domingo Juan Palmero, Agostina Pontarelli, Apostolos Papavasileiou, Emanuele Pontali, Rodolfo Romero Leyet, Antonio Spanevello, Zarir Farokh Udwadia, Pietro Viggiani, Dina Visca, Giovanni Sotgiu, Giovanni Battista Migliori
- Infections with the agent of ‘kennel cough’ in patients with cancer
- Ariel D. Szvalb, Kenneth V. Rolston, Nobuyoshi Mori, Jeffrey J. Tarrand, Victor E. Mulanovich
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?