Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention

被引：93

作者：

Wouthuyzen-Bakker, Marjan ^{[1
]}

Sebillotte, Marine ^{[2
]}

Lomas, Jose ^{[3
]}

Taylor, Adrian ^{[3
]}

Palomares, Eva Benavent ^{[4
]}

Murillo, Oscar ^{[4
]}

Parvizi, Javad ^{[5
]}

Shohat, Noam ^{[5
,6
]}

Reinoso, Javier Cobo ^{[7
]}

Sanchez, Rosa Escudero ^{[7
]}

Fernandez-Sampedro, Marta ^{[8
]}

Senneville, Eric ^{[9
]}

Huotari, Kaisa ^{[10
,11
]}

Barbero, Jose Maria ^{[12
]}

Garcia-Canete, Joaquin ^{[13
]}

Lora-Tamayo, Jaime ^{[14
]}

Ferrari, Matteo Carlo ^{[15
,16
]}

Vaznaisiene, Danguole ^{[17
]}

Yusuf, Erlangga ^{[18
]}

Aboltins, Craig ^{[19
,20
]}

Trebse, Rihard ^{[21
]}

Salles, Mauro Jose ^{[22
]}

Benito, Natividad ^{[23
]}

Vila, Andrea ^{[24
]}

Del Toro, Maria Dolores ^{[25
]}

Kramer, Tobias Siegfried ^{[26
,27
]}

Petersdorf, Sabine ^{[28
,29
]}

Diaz-Brito, Vicens ^{[30
]}

Tufan, Zeliha Kocak ^{[31
]}

Sanchez, Marisa ^{[32
]}

Arvieux, Cedric ^{[2
,33
]}

Soriano, Alex ^{[34
]}

机构：

[1] Univ Groningen, Univ Med Ctr Groningen, Dept Med Microbiol & Infect Prevent, Hanzepl 1, NL-9713 GZ Groningen, Netherlands

[2] Rennes Univ Hosp, Dept Infect Dis & Intens Care Med, Rennes, France

[3] Oxford Univ Hosp NHS Fdn Trust, Nuffield Orthopaed Ctr, Bone Infect Unit, Oxford, England

[4] IDIBELL Hosp Univ Bellvitge, Infect Dis Serv, Barcelona, Spain

[5] Thomas Jefferson Univ Hosp, Rothman Inst, Philadelphia, PA 19107 USA

[6] Tel Aviv Univ, Dept Orthopaed Surg, Tel Aviv, Israel

[7] Hosp Univ Ramon y Cajal, Serv Enfermedades Infecciosas, IRYCIS, Madrid, Spain

[8] Hosp Univ Marques de Valdecilla IDIVAL, Dept Med, Infect Dis Unit, Cantabria, Spain

[9] Univ Hosp Gustave Dron Hosp, Dept Infect Dis, Tourcoing, France

[10] Helsinki Univ Hosp, Peijas Hosp, Inflammat Ctr, Infect Dis, Helsinki, Finland

[11] Univ Helsinki, Helsinki, Finland

[12] Hosp Univ Principe Asturias, Dept Internal Med, Madrid, Spain

[13] UAM, Dept Internal Med Emergency, IIS Fdn Jimenez Diaz, Av Reyes Catolicas 2, Madrid 28040, Spain

[14] Hosp Univ 12 Octubre, Inst Invest i 12, Dept Internal Med, Madrid, Spain

[15] Humanitas Res Hosp, Dept Prosthet, Joint Replacement & Rehabil Ctr, Milan, Italy

[16] Humanitas Univ, Milan, Italy

[17] Lithuanian Univ Hlth Sci, Kaunas Clin Hosp, Med Acad, Dept Infect Dis, Kaunas, Lithuania

[18] Univ Antwerp, Antwerp Univ Hosp UZA, Dept Microbiol, Edegem, Belgium

[19] Northern Hlth, Dept Infect Dis, Melbourne, Vic, Australia

[20] Univ Melbourne, Northern Clin Sch, Melbourne, Vic, Australia

[21] Valdoltra Orthopaed Hosp, Serv Bone Infect, Ankaran, Slovenia

[22] Santa Casa Sao Paulo Sch Med Sci, Sao Paulo, Brazil

[23] Univ Autonoma Barcelona, Inst Invest Biomed St Pau, Hosp Santa Creu & St Pau, Dept Internal Med,Infect Dis Unit, Barcelona, Spain

[24] Hosp Italiano Mendoza, Serv Infectol, Mendoza, Argentina

[25] Univ Seville, Inst Biomed Sevilla IBIS, Unidad Clin Enfermedades Infecciosa & Microbiol, Seville, Spain

[26] Charite, Inst Hyg & Umweltmed, Natl Referenzzentrum Surveillance Nosokomialen In, Berlin, Germany

[27] GmbH MVZ, LADR, Neuruppin, Germany

[28] Heinrich Heine Univ, Inst Med Microbiol, Dusseldorf, Germany

[29] Heinrich Heine Univ, Hosp Hyg Univ Hosp, Dusseldorf, Germany

[30] Parc Sanitari St Joan Deu, Infect Dis Unit, Barcelona, Spain

[31] Ankara Yildirim Beyazit Univ, Ataturk Training & Res Hosp, Infect Dis & Clin Microbiol Dept, Ankara, Turkey

[32] Hosp Italiano Buenos Aires, Internal Med Serv, Infect Dis Sect, Buenos Aires, DF, Argentina

[33] Great West Reference Ctr Complex Bone & Joint Inf, Rennes, France

[34] Univ Barcelona, Hosp Clin, Serv Infect Dis, Barcelona, Spain

来源：

JOURNAL OF INFECTION | 2019年 / 78卷 / 01期

关键词：

Prosthetic joint infection; Acute; Hematogenous; Risk factors; failure; PREDICTORS; EFFICACY;

D O I：

10.1016/j.jinf.2018.07.014

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

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 patient's age, comorbidity, clinical presentation and microorganism causing the infection. (C) 2018 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

引用

页码：40 / 47

页数：8

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