Antibiotic therapy duration for prosthetic joint infections treated by Debridement and Implant Retention (DAIR): Similar long-term remission for 6 weeks as compared to 12 weeks. (October 2017)

• Record Type: Journal Article
• Authors: Chaussade, Hélène; Uçkay, Ilker; Vuagnat, Albert; Druon, Jérôme; Gras, Guillaume; Rosset, Philippe; Lipsky, Benjamin A.; Bernard, Louis
• Is Part Of: International journal of infectious diseases. Volume 63(2017:Oct.)
• Page Start: 37
• Page End: 42
• Publication Date: 2017-10
• Subjects: PJI prosthetic joint infection -- DAIR debridement and implant retention -- MRSA methicillin-resistant Staphylococcus aureus -- IDSA Infectious Diseases Society of America -- 95%CI 95% confidence interval; Prosthetic joint infections -- Debridement and retention -- Antibiotic duration -- Rifampin; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2017.08.002
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: A minority of all prosthetic joint infections are treated with the DAIR procedure. In prosthetic joint infections treated with the DAIR procedure, post-surgical duration of systemic antibiotic therapy after DAIR could be reduced to as short as 6 weeks. Abstract: Background: The required duration of antibiotic treatment for prosthetic joint infections (PJI) with debridement and retention of the implant (DAIR procedure) is unknown. Methods: Multicenter retrospective study emphasizing the duration of antibiotic therapy in patients treated with by DAIR. Results: We included 87 hip or knee PJI episodes in 87 patients from three university hospitals in France and Switzerland. All debridements were performed within 3 weeks of symptom onset. After a mean follow-up of 52.1 months, 60 patients with PJI (69%) remained in remission, with no significant difference between hip and knee cases (73.3% vs. 59.3%, 95% confidence interval (CI), 0.20–1.38), or between patients receiving 6 compared with 12 weeks of antibiotic treatment (70.5% vs.67.4%, 95%CI 0.27–2.10, p = 0.60). Methicillin-resistant Staphylococcus aureus was isolated from 13.8% of infections and this was the only variable associated with a poorer outcome (remission in 41.7% vs. 73.3% for those with other pathogens, 95%CI 0.05–0.77, p = 0.02). Conclusions: In patients undergoing DAIR for hip or knee PJI, the likelihood of long-term remission was not significantly different for those receiving 6 versus 12 weeks of antibiotic therapy. Prospective randomized trials are required to confirm this observation.