Dual Surgical Setup May Improve Infection Control Rate of Debridement and Implant Retention Procedures for Periprosthetic Infections of the Hip and Knee

AbstractThe economic crisis that has been seen worldwide affects developing countries such as Brazil even more severely. Worsening budget shortfalls for the healthcare system progressively threaten patient care. Infection control programs also are affected, and basic preventive policies are not implemented. Infection control practitioners face lack of equipment and poor microbiological support. In contrast, the motivation of the infection control people can be maintained through training courses, conferences, and meetings. Administrative support may be the most important single factor determining success in decreasing the infection control rate and should be (but is not always) provided, given that several infection control measures are cost effective.

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High Infection Control Rate and Function After Routine One-stage Exchange for Chronically Infected TKA

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-012-2480-7 ◽

2012 ◽

Vol 471 (1) ◽

pp. 238-243 ◽

Cited By ~ 40

Author(s):

Jean-Yves Jenny ◽

Bruno Barbe ◽

Jeannot Gaudias ◽

Cyril Boeri ◽

Jean-Noël Argenson

Keyword(s):

Infection Control ◽

Infection Control Rate ◽

One Stage ◽

High Infection ◽

And Function

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Antibiotic cement plate composite structure internal fixation after debridement of bone infection

Scientific Reports ◽

10.1038/s41598-021-96522-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xiaohua Wang ◽

Shulin Wang ◽

Jianzhong Xu ◽

Dong Sun ◽

Jie Shen ◽

...

Keyword(s):

Infection Control ◽

Internal Fixation ◽

Composite Structure ◽

Bone Infection ◽

Control Effect ◽

Fixation Failure ◽

Infection Control Rate ◽

Antibiotic Cement ◽

Epidermal Necrosis

AbstractAn internal fixation composite structure of antibiotic cement plates was created. The aim of this study was to analyse the infection control effect of this structure when applied to treat a bone infection. We retrospectively analysed patients with bone infection admitted to our hospital between January 2013 and June 2019. After debridement, an antibiotic cement plate composite structure was used to fill and stabilize the defects. The treatment effect was evaluated at six months after surgery, and the infection control rate, factors associated with the recurrence of infection, and complications were analysed. If the patients had bone defects, the defect was repaired after infection control, and the infection control rate of all of the patients was re-evaluated at 12 months after surgery. A total of 548 patients were treated with this technique, including 418 men and 130 women. The infection sites included 309 tibias, 207 femurs, 16 radii and ulnae, 13 humeri, and 3 clavicles. After at least 6 months of follow-up, 92 patients (16.79%) had an infection recurrence and needed further treatment. The recurrence rate of the tibia was higher than that of the femur (P = 0.025). Eighty-nine out of 92 patients who relapsed underwent a second debridement with the same method, and the infection control rate after the second debridement was 94.71%. Complications included 8 cases of epidermal necrosis around the incision, 6 cases of internal fixation failure, and 30 cases of lower limb swelling. By the follow-up time of 12 months, another 6 patients had experienced recurrence of infection, and 4 cases were controlled after debridement. Finally, among all 548 cases, 7 patients remained persistently infected, and 6 underwent amputation. The infection control rate was 97.6% at the 1-year follow-up. The clinical efficacy of this new antibiotic cement plate composite structure for internal fixation after debridement of bone infection is stable and reliable.

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Daptomycin for the treatment of gram-positive periprosthetic hip infections: Can daptomycin prevent the implant removal?

10.21203/rs.2.19918/v1 ◽

2020 ◽

Author(s):

Kenichi Oe ◽

Masahiro Sawada ◽

Hiroshi Kawamura ◽

Narumi Ueda ◽

Tomohisa Nakamura ◽

...

Keyword(s):

Infection Control ◽

Recurrent Infection ◽

Implant Removal ◽

Risk Scores ◽

Chronic Infections ◽

Preoperative Risk ◽

Retention Group ◽

Final Treatment ◽

Implant Retention ◽

Thorough Debridement

Abstract Background: Management of periprosthetic hip infections (PHIs) generally consists of implant removal and thorough debridement, accompanied by appropriate antibiotic therapy. Daptomycin (DAP) is a novel antibiotic, which allowed for implant retention in several patients after treating their infected joints. However, there is no consensus about implant retention or removal during treatment of PHIs. The aim of this study was to examine the effect of DAP, and to determine a surgical treatment strategy. Methods: This study retrospectively evaluated 20 patients between August 2014 and December 2018, divided into implant retention (n = 9) and implant removal groups (n = 11). Infection control and risk of recurrent infection were evaluated. Infection control was defined as not requiring implant removal after the final treatment. Results: Infection control rates in implant retention and implant removal groups were 67% and 90%, respectively. All late chronic infections resulted in failure cases within the implant retention group. In the implant retention group, mean preoperative risk scores for successful cases were significantly higher than those for failure cases (P < 0.05). Conclusions: Patients with low-risk did not require implant removal, suggesting that DAP may be a breakthrough alternative to traditional PHI management.

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Daptomycin for the treatment of gram-positive periprosthetic hip infections: Can daptomycin prevent the implant removal?

10.21203/rs.2.16186/v1 ◽

2019 ◽

Author(s):

Kenichi Oe ◽

Masahiro Sawada ◽

Hiroshi Kawamura ◽

Narumi Ueda ◽

Tomohisa Nakamura ◽

...

Keyword(s):

Infection Control ◽

Recurrent Infection ◽

Implant Removal ◽

Risk Scores ◽

Chronic Infections ◽

Preoperative Risk ◽

Retention Group ◽

Final Treatment ◽

Implant Retention ◽

Thorough Debridement

Abstract Background: Management of periprosthetic hip infections (PHIs) generally consists of implant removal and thorough debridement, accompanied by appropriate antibiotic therapy. Daptomycin (DAP) is a novel antibiotic, which allowed for implant retention in several patients after treating their infected joints. However, there is no consensus about implant retention or removal during treatment of PHIs. The aim of this study was to examine the effect of DAP, and to determine a surgical treatment strategy. Methods: This study retrospectively evaluated 20 patients between August 2014 and December 2018, divided into implant retention (n = 9) and implant removal groups (n = 11). Infection control and risk of recurrent infection were evaluated. Infection control was defined as not requiring implant removal after the final treatment. Results: Infection control rates in implant retention and implant removal groups were 67% and 90%, respectively. All late chronic infections resulted in failure cases within the implant retention group. In the implant retention group, mean preoperative risk scores for successful cases were significantly higher than those for failure cases (p < 0.05). Conclusions: Patients with low-risk did not require implant removal, suggesting that DAP may be a breakthrough alternative to traditional PHI management.

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Outcomes following debridement, antibiotics and implant retention in the management of periprosthetic infections of the hip

The Bone & Joint Journal ◽

10.1302/0301-620x.99b11.bjj-2017-0088.r1 ◽

2017 ◽

Vol 99-B (11) ◽

pp. 1458-1466 ◽

Cited By ~ 47

Author(s):

S-T. J. Tsang ◽

J. Ting ◽

A. H. R. W. Simpson ◽

P. Gaston

Keyword(s):

Implant Retention ◽

Periprosthetic Infections

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Effective treatment of single-stage revision using intra-articular antibiotic infusion for culture-negative prosthetic joint infection

The Bone & Joint Journal ◽

10.1302/0301-620x.102b3.bjj-2019-0820.r1 ◽

2020 ◽

Vol 102-B (3) ◽

pp. 336-344 ◽

Cited By ~ 6

Author(s):

Baochao Ji ◽

Guoqing Li ◽

Xiaogang Zhang ◽

Yang Wang ◽

Wenbo Mu ◽

...

Keyword(s):

Infection Control ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Single Stage ◽

Harris Hip Score ◽

Infection Control Rate ◽

Prosthetic Joint ◽

Significant Difference ◽

Culture Negative ◽

Antibiotic Infusion

Aims In the absence of an identified organism, single-stage revision is contraindicated in prosthetic joint infection (PJI). However, no studies have examined the use of intra-articular antibiotics in combination with single-stage revision in these cases. In this study, we present the results of single-stage revision using intra-articular antibiotic infusion for treating culture-negative (CN) PJI. Methods A retrospective analysis between 2009 and 2016 included 51 patients with CN PJI who underwent single-stage revision using intra-articular antibiotic infusion; these were compared with 192 culture-positive (CP) patients. CN patients were treated according to a protocol including intravenous vancomycin and a direct intra-articular infusion of imipenem and vancomycin alternately used in the morning and afternoon. In the CP patients, pathogen-sensitive intravenous (IV) antibiotics were administered for a mean of 16 days (12 to 21), and for resistant cases, additional intra-articular antibiotics were used. The infection healing rate, Harris Hip Score (HHS), and Hospital for Special Surgery (HSS) knee score were compared between CN and CP groups. Results Of 51 CN patients, 46 (90.2%) required no additional medical treatment for recurrent infection at a mean of 53.2 months (24 to 72) of follow-up. Impaired kidney function occurred in two patients, and one patient had a local skin rash. No significant difference in the infection control rate was observed between CN and CP PJIs (90.2% (46/51) versus 94.3% (181/192); p = 0.297). The HHS of the CN group showed no substantial difference from that of CP cases (79 versus 81; p = 0.359). However, the CN group showed a mean HSS inferior to that of the CP group (76 versus 80; p = 0.027). Conclusion Single-stage revision with direct intra-articular antibiotic infusion can be effective in treating CN PJI, and can achieve an infection control rate similar to that in CP patients. However, in view of systemic toxicity, local adverse reactions, and higher costs, additional strong evidence is needed to verify these treatment regimens. Cite this article: Bone Joint J 2020;102-B(3):336–344

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One-year infection control rates of a DAIR (debridement, antibiotics and implant retention) procedure after primary and prosthetic-joint-infection-related revision arthroplasty – a retrospective cohort study

Journal of Bone and Joint Infection ◽

10.5194/jbji-6-91-2021 ◽

2021 ◽

Vol 6 (4) ◽

pp. 91-97

Author(s):

F. Ruben H. A. Nurmohamed ◽

Bruce van Dijk ◽

Ewout S. Veltman ◽

Marrit Hoekstra ◽

Rob J. Rentenaar ◽

...

Keyword(s):

Infection Control ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Musculoskeletal Infection ◽

Primary Arthroplasty ◽

Prosthetic Joint ◽

Successful Infection ◽

Significant Difference ◽

Implant Retention

Abstract. Introduction: Debridement, antibiotics and implant retention (DAIR) procedures are effective treatments for acute postoperative or acute hematogenous periprosthetic joint infections. However, literature reporting on the effectiveness of DAIR procedures performed after a one- or two-stage revision because of a prosthetic joint infection (PJI) (PJI-related revision arthroplasty) is scarce. The aim of this study is to retrospectively evaluate the infection control after 1 year of a DAIR procedure in the case of an early postoperative infection either after primary arthroplasty or after PJI-related revision arthroplasty. Materials and methods: All patients treated with a DAIR procedure within 3 months after onset of PJI between 2009 and 2017 were retrospectively included. Data were collected on patient and infection characteristics. All infections were confirmed by applying the Musculoskeletal Infection Society (MSIS) 2014 criteria. The primary outcome was successful control of infection at 1 year after a DAIR procedure, which was defined as the absence of clinical signs, such as pain, swelling, and erythema; radiological signs, such as protheses loosening; or laboratory signs, such as C-reactive protein (CRP) (<10) with no use of antibiotic therapy. Results: Sixty-seven patients were treated with a DAIR procedure (41 hips and 26 knees). Successful infection control rates of a DAIR procedure after primary arthroplasty (n=51) and after prior PJI-related revision arthroplasty (n=16) were 69 % and 56 %, respectively (p=0.38). The successful infection control rates of a DAIR procedure after an early acute infection (n=35) and after a hematogenous infection (n=16) following primary arthroplasty were both 69 % (p=1.00). Conclusion: In this limited study population, no statistically significant difference is found in infection control after 1 year between DAIR procedures after primary arthroplasty and PJI-related revision arthroplasty.

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Efficiency of Surgical Debridement and Implant Retaining in Treatment of Early Postoperative and Acute Hematogenous Periprosthetic Infections of Hip

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2021-27-2-23-33 ◽

2021 ◽

Vol 27 (2) ◽

pp. 23-33

Author(s):

A. S. Tryapichnikov ◽

A. M. Ermakov ◽

T. A. Silantieva ◽

A. V. Burtsev

Keyword(s):

Periprosthetic Infection ◽

Life Quality ◽

Surgical Debridement ◽

Harris Hip Score ◽

Duration Of Treatment ◽

Reinfection Rate ◽

Implant Retention ◽

The Mean ◽

Periprosthetic Infections

Background. Periprosthetic infection is a devastating complication that influences the duration of treatment and patients life quality. Debridement, Antibiotics and Implant Retention (DAIR) is considered as least invasive surgery patients with stable implant, except cases of chronical periprosthetic infection. The aim of this study was to evaluate efficiency of surgical debridement and implant retaining in control over infection in group patients with early postoperative and acute hematogenous periprosthetic infections. Materials and Methods.We performed retrospective monocentral cohort study of treatment early postoperative and acute hematogenous periprosthetic infections of hip in 26 patients. The group included cases with stable implants and period between manifestation of infection and DAIR no more than 4 weeks. We have classified infection as early postoperative in 22 patients (84,2%) and as acute hematogenous in 4 cases (15,8%). Results.At mean follow-up 42,8±2,3 mounts five patients underwent removal of implant due to reinfection. We performed successful twostage revision for four of them and had to perform resection arthroplasty in one case. Thus, DAIR protocol was successful in 80,8(%) cases. The mean Harris Hip Score significantly improved compared to preoperative values from 59,2±2,5 to 80,5±1,3 at the last follow-up (p = 0,0002, Z-3,7). Conclusions.The efficiency of DAIR according to our data was 80,8%. These results allow to consider DAIR as a method of treatment of patients with early postoperative and acute hematogenous periprosthetic infections. Exchange of modular components can decrease the reinfection rate.

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