Debridement, Antibiotics, and Implant Retention Is a Viable Treatment Option for Early Periprosthetic Joint Infection Presenting More Than 4 Weeks After Index Arthroplasty. (31st August 2019)

• Record Type: Journal Article
• Authors: Löwik, Claudia A M; Parvizi, Javad; Jutte, Paul C; Zijlstra, Wierd P; Knobben, Bas A S; Xu, Chi; Goswami, Karan; Belden, Katherine A; Sousa, Ricardo; Carvalho, André; Martínez-Pastor, Juan Carlos; Soriano, Alex; Wouthuyzen-Bakker, Marjan
• Is Part Of: Clinical infectious diseases. Volume 71:Number 3(2020)
• Page Start: 630
• Page End: 636
• Publication Date: 2019-08-31
• Subjects: joint arthroplasty -- early prosthetic joint infection -- DAIR -- failure -- time interval; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciz867
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: The success of debridement, antibiotics, and implant retention (DAIR) in early periprosthetic joint infection (PJI) largely depends on the presence of a mature biofilm. At what time point DAIR should be disrecommended is unknown. This multicenter study evaluated the outcome of DAIR in relation to the time after index arthroplasty. Methods: We retrospectively evaluated PJIs occurring within 90 days after surgery and treated with DAIR. Patients with bacteremia, arthroscopic debridements, and a follow-up <1 year were excluded. Treatment failure was defined as (1) any further surgical procedure related to infection; (2) PJI-related death; or (3) use of long-term suppressive antibiotics. Results: We included 769 patients. Treatment failure occurred in 294 patients (38%) and was similar between time intervals from index arthroplasty to DAIR: the failure rate for Week 1–2 was 42% (95/226), the rate for Week 3–4 was 38% (143/378), the rate for Week 5–6 was 29% (29/100), and the rate for Week 7–12 was 42% (27/65). An exchange of modular components was performed to a lesser extent in the early post-surgical course compared with the late course (41% vs 63%, respectively; P < .001). The causative microorganisms, comorbidities, and durations of symptoms were comparable between time intervals. Conclusions: DAIR is a viable option in patients with early PJI presenting more than 4 weeks after index surgery, as long as DAIR is performed within at least 1 week after the onset of symptoms and modular components can be exchanged. Abstract : Debridement, antibiotics, and implant retention (DAIR) is a viable treatment option in patients with early periprosthetic joint infections presenting >4 weeks after index surgery, provided that DAIR is performed <1 week after symptom onset and modular components can be exchanged.