Preoperative Anemia Is Associated With Failure of Open Debridement Polyethylene Exchange in Acute and Acute Hematogenous Prosthetic Joint Infection

Swenson, Richard D.; Butterfield, James; Irwin, Timothy J.; Zurlo, John; Davis, Charles M.

doi:10.1016/j.arth.2018.01.042

Cited by 20 publications

(9 citation statements)

References 27 publications

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“…Regarding the variables identified, the Charlson index is a predictor of survival and also of prognosis of many infections; similarly, other studies have used the ASA index [5] or C 2 comorbidities for similar reasons [11]. Anaemia was previously identified as a predictor in one study [16], but was not assessed at all in most of the others. Anaemia is a potential marker of nutritional status that can increase tissue hypoxia or even indicate a systemic inflammatory process.…”

Section: Discussionmentioning

confidence: 99%

“…Establishing a threshold is complex. The 21-day threshold for performing DAIR recommended by the guidelines [9] was based on one small-scale study experience [19], and a delay of [ 2 days in patients with SA-PJI treated with beta-lactams was associated with increased TF in another study [2] but not when a rifampicin-fluoroquinolone combination was used [6][7][8][9][10][11][12][13][14]16]. In our cohort, we found an increased risk for each day of delay, supporting the recommendation that debridement should be performed as early as possible.…”

Section: Discussionmentioning

confidence: 99%

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Rates and Predictors of Treatment Failure in Staphylococcus aureus Prosthetic Joint Infections According to Different Management Strategies: A Multinational Cohort Study—The ARTHR-IS Study Group

et al. 2022

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Introduction:Guidelines have improved the management of prosthetic joint infections (PJI).However, it is necessary to reassess the incidence and risk factors for treatment failure (TF) of Staphylococcus aureus PJI (SA-PJI) including functional loss, which has so far been neglected as an outcome. Methods: A retrospective cohort study of SA-PJI was performed in 19 European hospitals between 2014 and 2016. The outcome variable was TF, including related mortality, clinical failure and functional loss both after the initial surgical procedure and after all procedures at 18 months. Predictors of TF were identified by logistic regression. Landmark analysis was used Jesu ´s Rodrı ´guez-Ban ˜o and Maria Dolores del Toro contributed equally as senior authors of the study.Members of The ARTHR-IS Group are listed in Acknowledgements section.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rates and Predictors of Treatment Failure in Staphylococcus aureus Prosthetic Joint Infections According to Different Management Strategies: A Multinational Cohort Study—The ARTHR-IS Study Group

et al. 2022

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“…Limited cases or a lack of reliable statistical methods may explain this difference. Other studies ( 9 , 15 , 22 ) were unable to detect a longer duration of symptoms as a predictor of failure for DAIR. However, all of these studies included only acute or acute hematogenous PJIs, which indicates that the duration of symptoms in all patients was inherently short.…”

Section: Discussionmentioning

confidence: 89%

“…We also collected preoperative laboratory results, including serum C reactive protein (CRP), hemoglobin, albumin, and perioperative culture results. According to current clinical practice and previous studies (21)(22)(23), the continuous variables were categorized into groups (age ≥60 years and <60 years; BMI ≥35 kg/m 2 and <35 kg/ m 2 ; CCI ≥4 and <4; CRP ≥115 mg/L and <115 mg/L; hemoglobin ≥110 g/L and <110 g/L and albumin ≥35 g/L and <35 g/L). We also recorded the type of index surgery (primary or revision and hip or knee), whether the patient had a sinus tract, and whether the modular components were retained or exchanged.…”

Section: Data Collection and Outcome Assessmentmentioning

confidence: 99%

Symptom duration is associated with failure of periprosthetic joint infection treated with debridement, antibiotics and implant retention

Shao

Li²,

Wang³

et al. 2022

Front. Surg.

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BackgroundDebridement, antibiotics, and implant retention (DAIR) is an alternative treatment strategy for periprosthetic joint infection (PJI). However, no consensus exists regarding which patient population(s) may be most suitable for DAIR. This study aims to investigate the overall infection control rate and explore the prognostic factors associated with acute, hematogenous, and chronic PJIs treated with DAIR.MethodsWe retrospectively reviewed the included patients who were diagnosed with PJI and underwent DAIR at two institutions from 2009 to 2018 (n = 104). We collected the clinical data, including demographics, preoperative laboratory tests, Charlson Comorbidity Index, surgical information, and culture organism results. Treatment success was defined according to the criteria reported by Diaz-Ledezma. All patients were followed for at least one year unless failure preceded that time point. A multivariable analysis was utilized to identify prognostic factors associated with treatment, and a Kaplan-Meier survival analysis was used to depict the infection control rate.ResultsThe overall treatment success rate in the current cohort of patients was 67.3% at a median 38.6 (interquartile range: 23.5, 90.7) months follow-up. Patients with a duration of infectious symptoms of more than ten days were more likely to fail (P = 0.035, hazard ratio 8.492, 95% confidence interval 1.159–62.212). There was no difference among acute, hematogenous, and chronic infections in terms of failure rate (P = 0.161).ConclusionsDAIR is a reasonable treatment option for PJI, and its use in the setting of chronic infection does not appear to be a contraindication. Performing DAIR within ten days of the presentation of symptoms had a higher rate of treatment success.

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“…According to a previous study, the infected sites could be isolated from the external environment due to the focal closed negative pressure environment formed by VSD[18], because of which we believed there is a chance to apply VSD in deep infection as an adjunct to DAIR for better infection control as the relatively closed environment around the infected prosthesis could further prevent the invasion of additional bacteria after a thorough debridement and irrigation. Several factors are supposed to be associated with the outcome of DAIR such as type of causative organism [19,20], duration between symptoms and surgery [21,22], exchange of modular components[6, 23], and preoperative comorbidities [24]. Besides, the drainage in the operative area was also essential to the success rate of DAIR.…”

Section: Discussionmentioning

confidence: 99%

Debridement, Antibiotics, and Implant Retention with Vacuum Sealing Drainage in Deep Portion for Acute Periprosthetic Joint Infection of the Hip

Peng

Zhang

et al. 2022

Preprint

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Background The treatment of acute periprosthetic joint infection (PJI) remains a great challenge. This study aimed to explore the efficacy of vacuum sealing drainage (VSD) used as an adjunct to debridement, antibiotics, and implant retention (DAIR) for acute periprosthetic joint infection of the hip. Methods Patients undergoing debridement, irrigation with component retention, and application of vacuum seal drainage in the deep portion surrounding the infected sites from January 2014 to February 2021 were retrospectively reviewed. The definition of failure included the requirement of prosthesis removal; persistent infection-related symptoms; suppressive antibiotics therapy due to failure of controlling the infection; infection-related death. Results 11 patients were included in this study with a mean follow-up of 32.3 ± 18.3 months. There were 9 males and 2 females with a mean age of 58.6 ± 16.3 years. Eight had sinus tract. The overall success rate was 81.82% with 2 failures. The Harris Hip Scores (HHS) improved in the last follow-up compared with preoperative evaluation (83.0 ± 11.6 vs 43.9 ± 11.8, t=-13.58, P༜0.001). Conclusion The addition of VSD in the deep portion does improve the outcome of DAIR, which might be a safe and effective option for acute PJI.

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Preoperative Anemia Is Associated With Failure of Open Debridement Polyethylene Exchange in Acute and Acute Hematogenous Prosthetic Joint Infection

Cited by 20 publications

References 27 publications

Rates and Predictors of Treatment Failure in Staphylococcus aureus Prosthetic Joint Infections According to Different Management Strategies: A Multinational Cohort Study—The ARTHR-IS Study Group

Rates and Predictors of Treatment Failure in Staphylococcus aureus Prosthetic Joint Infections According to Different Management Strategies: A Multinational Cohort Study—The ARTHR-IS Study Group

Symptom duration is associated with failure of periprosthetic joint infection treated with debridement, antibiotics and implant retention

Debridement, Antibiotics, and Implant Retention with Vacuum Sealing Drainage in Deep Portion for Acute Periprosthetic Joint Infection of the Hip

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