Abstract
Aim
Debridement, antibiotics and implant retention (DAIR) is the recommended treatment for all acute prosthetic joint infections (PJI). However, the efficacy of DAIR and identification of risk factors for failure in patients with late acute PJI, is not well described.
Method
Patients diagnosed with late acute PJI between 2005 and 2015 were retrospectively evaluated. Late acute 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 due to persistent signs of infection 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). 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), COPD (OR 2.9), 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).
Conclusions
Late acute PJIs have a high failure rate. Treatment strategies should be individualized according to patients' age, comorbidity, clinical presentation and microorganism causing the infection.
