Timing of implant-removal in late acute periprosthetic joint infection: A multicenter observational study
Por:
Wouthuyzen-Bakker, M, Sebillotte, M, Lomas, J, Kendrick, B, Palomares, EB, Murillo, O, Parvizi, J, Shohat, N, Reinoso, JC, Sanchez, RE, Fernandez-Sampedro, M, Senneville, E, Huotari, K, Allende, JMB, Garcia, AB, Lora-Tamayo, J, Ferrari, MC, Vaznaisiene, D, Yusuf, E, Aboltins, C, Trebse, R, Salles, MJ, Benito, N, Vila, A, Del Toro, MD, Kramer, TS, Petersdorf, S, Diaz-Brito, V, Tufan, ZK, Sanchez, M, Arvieux, C, Soriano, A, Gougeon, A, Common, H, Meheut, A, Gomez-Junyent, J, Tarabichi, M, Demirturk, A, Ribeiro, T, Honda, E, Polesello, G, Jutte, P, Ploegmakers, J, Lowik, C, Bori, G, Morata, L, Lozano, L, Mancheno, M, Chaves, F, Smolders, D, Inthavong, P, Taylor, A, Digumber, M, Pfang, BG, Tornero, E, Moreno, E, Noth, U, Rivero, C, Coll, P, Crusi, X, Mur, I, Dapas, J, Tattevin, P, Esteban, J, Garcia-Canete, J, Scarborough, M
Publicada:
1 sep 2019
Resumen:
Objectives: We evaluated the treatment outcome in late acute (LA) periprosthetic joint infections (PJI) treated with debridement and implant retention (DAIR) versus implant removal.
Methods: In a large multicenter study, LA PJIs of the hip and knee were retrospectively evaluated. Failure was defined as: PJI related death, prosthesis removal or the need for suppressive antibiotic therapy. LA PJI was defined as acute symptoms <3 weeks in patients more than 3 months after the index surgery and with a history of normal joint function.
Results: 445 patients were included, comprising 340 cases treated with DAIR and 105 cases treated with implant removal (19% one-stage revision (n = 20), 74.3% two-stage revision (n = 78) and 6.7% definitive implant removal (n = 7). Overall failure in patients treated with DAIR was 45.0% (153/340) compared to 24.8% (26/105) for implant removal (p < 0.001). Difference in failure rate remained after 1: 1 propensityscore matching. A preoperative CRIME80-score >= 3 (OR 2.9), PJI caused by S. aureus (OR 1.8) and implant retention (OR 3.1) were independent predictors for failure in the multivariate analysis.
Conclusion: DAIR is a viable surgical treatment for most patients with LA PJI, but implant removal should be considered in a subset of patients, especially in those with a CRIME80-score >= 3. (C) 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Filiaciones:
Wouthuyzen-Bakker, M:
Univ Groningen, Univ Med Ctr Groningen, Dept Med Microbiol & Infect Prevent, Hanzepl 1, NL-9713 GZ Groningen, Netherlands
Sebillotte, M:
Rennes Univ Hosp, Dept Infect Dis & Intens Care Med, Rennes, France
Lomas, J:
Oxford Univ Hosp NHS Fdn Trust, Nuffield Orthopaed Ctr, Bone Infect Unit, Oxford, England
Kendrick, B:
Oxford Univ Hosp NHS Fdn Trust, Nuffield Orthopaed Ctr, Bone Infect Unit, Oxford, England
Palomares, EB:
IDIBELL Hosp Univ Bellvitge, Infect Dis Serv, Barcelona, Spain
Murillo, O:
IDIBELL Hosp Univ Bellvitge, Infect Dis Serv, Barcelona, Spain
Parvizi, J:
Thomas Jefferson Univ Hosp, Rothman Inst, Philadelphia, PA 19107 USA
Shohat, N:
Thomas Jefferson Univ Hosp, Rothman Inst, Philadelphia, PA 19107 USA
Tel Aviv Univ, Dept Orthopaed Surg, Tel Aviv, Israel
Reinoso, JC:
Hosp Univ Ramon y Cajal, Serv Enfermedades Infecciosas, IRYCIS, Madrid, Spain
Sanchez, RE:
Hosp Univ Ramon y Cajal, Serv Enfermedades Infecciosas, IRYCIS, Madrid, Spain
Fernandez-Sampedro, M:
Hosp Univ Marques de Valdecilla IDIVAL, Dept Med, Infect Dis Unit, Cantabria, Spain
Senneville, E:
Univ Hosp Gustave Dron Hosp, Dept Infect Dis, Tourcoing, France
Huotari, K:
Helsinki Univ Hosp, Peijas Hosp, Inflammat Ctr, Infect Dis, Helsinki, Finland
Univ Helsinki, Helsinki, Finland
Allende, JMB:
Hosp Univ Principe Asturias, Dept Internal Med, Madrid, Spain
Garcia, AB:
UAM, IIS Fdn Jimenez Diaz, Dept Internal Med Emergency, Av Reyes Catolicos 2, Madrid 28040, Spain
Lora-Tamayo, J:
Hosp Univ 12 Octubre, Inst Invest I 12, Dept Internal Med, Madrid 28040, Spain
Ferrari, MC:
Humanitas Res Hosp, Dept Prosthet Joint Replacement, Milan, Italy
Humanitas Res Hosp, Rehabil Ctr, Milan, Italy
Humanitas Univ, Milan, Italy
Vaznaisiene, D:
Lithuanian Univ Hlth Sci, Kaunas Clin Hosp, Med Acad, Dept Infect Dis, Kaunas, Lithuania
Yusuf, E:
Univ Antwerp, Antwerp Univ Hosp UZA, Dept Microbiol, Edegem, Belgium
Aboltins, C:
Northern Hlth, Dept Infect Dis, Melbourne, Vic, Australia
Univ Melbourne, Northern Clin Sch, Melbourne, Vic, Australia
Trebse, R:
Valdoltra Orthopaed Hosp, Serv Bone Infect, Ankaran, Slovenia
Salles, MJ:
Santa Casa Sao Paulo Sch Med Sci, Sao Paulo, Brazil
Benito, N:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Inst Invest Bomed St Pau, Dept Internal Med,Infect Dis Unit, Barcelona, Spain
Vila, A:
Hosp Italiano Mendoza, Serv Infectol, Mendoza, Argentina
Del Toro, MD:
Univ Seville, Inst Biomed Sevilla IBIS, Unidad Clin Enfermedades Infecciosa & Microbiol, Seville, Spain
Kramer, TS:
Charite, Natl Referenzzentrum Surveillance Nosokomialen, Inst Hyg & Umweltmed, Berlin, Germany
GmbH MVZ, LADR, Neuruppin, Germany
Petersdorf, S:
Heinrich Heine Univ, Hosp Hyg Univ Hosp, Inst Med Microbiol, Dusseldorf, Germany
Diaz-Brito, V:
IDIBAPS, Infect Dis Unit, Parc Sanitari St Joan de Deu, Barcelona, Spain
Tufan, ZK:
Ankara Yildirim Beyazit Univ, Ataturk Training & Res Hosp, Infect Dis & Clin Microbiol Dept, Ankara, Turkey
Sanchez, M:
Hosp Italiano Buenos Aires, Internal Med Serv, Infect Dis Sect, Buenos Aires, DF, Argentina
Arvieux, C:
Rennes Univ Hosp, Dept Infect Dis & Intens Care Med, Rennes, France
Great West Reference Ctr Complex Bone & Joint Inf, Rennes, France
Soriano, A:
Univ Barcelona, Hosp Clin, Serv Infect Dis, Barcelona, Spain
Green Published, Green Accepted
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