401. Predictors of Treatment Failure for Hip and Knee Prosthetic Joint Infections in the Setting of Prosthesis Removal: A Multi-Center Retrospective Cohort

Abstract Background Prosthetic hip and knee joint infections (PJIs) are challenging to eradicate despite prosthesis removal and long courses of antibiotics. We aimed to describe the risk factors for PJI treatment failure in a multicenter retrospective cohort. Methods A retrospective cohort of individuals who underwent prosthetic joint removal for a PJI at one of five hospitals in Toronto, Ontario, Canada from 2010–2014. Individuals eligible for the cohort were obtained by searching operative listings and PJIs were defined according to the criteria of the Musculoskeletal Infection Society. Treatment failure was defined as recurrent PJI, amputation, death or chronic antibiotic suppression. Potential risk factors for treatment failure were abstracted by chart review and assessed using a Cox proportional hazards model. Results 533 PJIs were analyzed over a median follow-up duration of 1102 days with 21 surgeons performing more than 5 revision arthroplasties for a PJI. Two-stage procedures were performed in 81% (430/533) and the most common organism was coagulase negative staphylococci (32%). Treatment failure occurred in 28% (150/533) over 1443 patient-years and was caused by a different bacterial species in 53% (56/105). On multivariate analysis the characteristics associated with PJI treatment failure included liver disease (adjusted hazard ratio (aHR) 3.12, 95% confidence interval (95% CI) 2.09–4.66), the presence of a sinus tract (aHR 1.53, 94% CI (1.12–2.10), preceding debridement with prosthesis retention (aHR 1.68, 95% CI 1.13–2.51), a one-stage procedure (aHR 1.72, 95% CI (1.28–2.32), and infection due to Gram-negative bacilli (aHR 1.35, 95% CI 1.04–1.76). Conclusion PJI treatment failure remains high despite prosthesis removal and the patient risk factors identified are non-modifiable. Novel treatment paradigms are urgently needed along with efforts to reduce orthopedic surgical site infections. Disclosures All authors: No reported disclosures.

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Predictors of Treatment Failure for Hip and Knee Prosthetic Joint Infections in the Setting of 1- and 2-Stage Exchange Arthroplasty: A Multicenter Retrospective Cohort

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz452 ◽

2019 ◽

Vol 6 (11) ◽

Cited By ~ 4

Author(s):

Christopher E Kandel ◽

Richard Jenkinson ◽

Nick Daneman ◽

David Backstein ◽

Bettina E Hansen ◽

...

Keyword(s):

Risk Factors ◽

Treatment Failure ◽

Retrospective Cohort ◽

Proportional Hazards Model ◽

Bacterial Species ◽

Cox Proportional Hazards Model ◽

Joint Infections ◽

Prosthesis Retention ◽

Prosthetic Joint Infections ◽

Prosthesis Removal

AbstractBackgroundProsthetic hip and knee joint infections (PJIs) are challenging to eradicate despite prosthesis removal and antibiotic therapy. There is a need to understand risk factors for PJI treatment failure in the setting of prosthesis removal.MethodsA retrospective cohort of individuals who underwent prosthesis removal for a PJI at 5 hospitals in Toronto, Canada, from 2010 to 2014 was created. Treatment failure was defined as recurrent PJI, amputation, death, or chronic antibiotic suppression. Potential risk factors for treatment failure were abstracted by chart review and assessed using a Cox proportional hazards model.ResultsA total of 533 individuals with prosthesis removal were followed for a median (interquartile range) of 814 (235–1530) days. A 1-stage exchange was performed in 19% (103/533), whereas a 2-stage procedure was completed in 88% (377/430). Treatment failure occurred in 24.8% (132/533) at 2 years; 53% (56/105) of recurrent PJIs were caused by a different bacterial species. At 4 years, treatment failure occurred in 36% of 1-stage and 32% of 2-stage procedures (P = .06). Characteristics associated with treatment failure included liver disease (adjusted hazard ratio [aHR], 3.12; 95% confidence interval [CI], 2.09–4.66), the presence of a sinus tract (aHR, 1.53; 95% CI, 1.12–2.10), preceding debridement with prosthesis retention (aHR, 1.68; 95% CI, 1.13–2.51), a 1-stage procedure (aHR, 1.72; 95% CI, 1.28–2.32), and infection due to Gram-negative bacilli (aHR, 1.35; 95% CI, 1.04–1.76).ConclusionsFailure of PJI therapy is common, and risk factors are not easily modified. Improvements in treatment paradigms are needed, along with efforts to reduce orthopedic surgical site infections.

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Risk factors for treatment failure in patients with prosthetic joint infections

Journal of Hospital Infection ◽

10.1016/j.jhin.2010.03.012 ◽

2010 ◽

Vol 75 (4) ◽

pp. 273-276 ◽

Cited By ~ 34

Author(s):

J. Lee ◽

C.-I. Kang ◽

J.H. Lee ◽

M. Joung ◽

S. Moon ◽

...

Keyword(s):

Risk Factors ◽

Treatment Failure ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

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252. Joint Decisions: Optimal Duration of Chronic Suppressive Antibiotics in Adults with Prosthetic Joint Infections Who Underwent Debridement, Antibiotics, Irrigation, and Retention of Prostheses

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.454 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S233-S233

Author(s):

Aung Lin ◽

Anil C Jagtiani

Keyword(s):

Treatment Failure ◽

Antibiotic Use ◽

Kaiser Permanente ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Optimal Duration ◽

Joint Decisions ◽

Prosthesis Removal ◽

Antibiotic Duration

Abstract Background Hip and knee arthroplasties are associated with complications including prosthetic joint infections (PJI). Management ranges from explantation to debridement, antibiotics, irrigation, and retention of prostheses (DAIR). In DAIR, patients receive intravenous antibiotics followed by chronic suppressive antibiotics. Current guidelines on suppressive antibiotic use after DAIR are unclear and based on expert consensus. This study seeks to elucidate the optimal duration of chronic suppressive antibiotics after DAIR. Methods This is a retrospective cohort study of adults in the Southern California Kaiser Permanente System with hip and knee prosthetic joint infections who underwent DAIR from 2007-2017. Culture data and durations of suppressive antibiotics were collected and patients were followed for 1 year after completion. Treatment failure was determined by mortality, re-infection, or prosthesis removal. Patients who received no antibiotics vs. less than 3 months vs 3 to 6 months vs greater than 1 year were compared. Results 350 charts were reviewed and 145 patients were included. There were 87 knee and 58 hip PJIs with 32 patients (22%) who failed treatment. There were more cases of failure when patients didn’t receive suppressive antibiotics (27%) vs those who received any (19%), however the results were not significant. There were no significant differences in failure rates between short vs longer suppressive antibiotic courses regardless of the duration (Staph vs non-Staph, hip vs knee). Patients with Staphyloccocal infections and knee infections were significantly more likely to fail treatment (p=0.0196 & 0.0150, logistic regression). Conclusion This study shows the importance of suppression with oral antibiotics after PJIs are treated with DAIR. The lack of difference in treatment failure between the durations of suppressive antibiotics makes it prudent to consider shorter courses of antibiotics, while placing attention on patients with knee and Staphylococcal infections as they are more likely to fail treatment. Limitations include sample size, difficulty in quantifying extent of initial infection and debridement, and provider dependent prolonging of antibiotic duration. Disclosures All Authors: No reported disclosures

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Corrigendum to “Risk factors for treatment failure in patients with prosthetic joint infections” [Journal of Hospital Infection 2010; 75: 273–276]

Journal of Hospital Infection ◽

10.1016/j.jhin.2010.08.001 ◽

2010 ◽

Vol 76 (3) ◽

pp. 281

Author(s):

J. Lee ◽

C.-I. Kang ◽

J.H. Lee ◽

M. Joung ◽

S. Moon ◽

...

Keyword(s):

Risk Factors ◽

Treatment Failure ◽

Hospital Infection ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

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Gram-negative prosthetic joint infections managed according to a multidisciplinary standardized approach: risk factors for failure and outcome with and without fluoroquinolones

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkw202 ◽

2016 ◽

Vol 71 (9) ◽

pp. 2593-2597 ◽

Cited By ~ 10

Author(s):

O. Grossi ◽

N. Asseray ◽

C. Bourigault ◽

S. Corvec ◽

M. Valette ◽

...

Keyword(s):

Risk Factors ◽

Treatment Failure ◽

Failure Rate ◽

Antibiotic Administration ◽

Gram Negative ◽

Joint Infections ◽

Prosthetic Joint ◽

Additional Surgery ◽

Prosthetic Joint Infections

Abstract Objectives To describe the outcome and risk factors for treatment failure of 76 Gram-negative bacilli (GNB) prosthetic joint infections (PJIs) managed with a curative intent according to a standardized protocol derived from published guidelines. Methods We analysed data from all the cases of GNB-PJI treated surgically over an 8 year period. Treatment failure was defined as persistence or recurrence of PJI signs during follow-up, resulting in additional surgery and/or antibiotic administration or death. Results Treatment failure within the follow-up period (median = 2.6 years) was observed in 16 of 76 (21.1%) patients. The failure rate was similar whether the patients were treated with fluoroquinolones in the whole cohort (22.4% versus 16.7%, P = 0.75) and after stratification according to the surgical procedure. The low failure rate observed in patients not receiving fluoroquinolones might be explained by the standardized attitude of maintaining intravenous β-lactams throughout treatment duration (median = 90 days). In multivariate analysis, C-reactive protein level ≥175 mg/L was significantly associated with treatment failure (adjusted HR = 7.75, 95% CI = 2.66–22.59, P < 0.0001). Conclusions Management according to standardized procedures may improve the prognosis of GNB-PJI. Intravenous β-lactams, continued for 3 months, should be considered an effective alternative to fluoroquinolones.

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Outcomes and Risk Factors in Prosthetic Joint Infections by multidrug-resistant Gram-negative Bacteria: A Retrospective Cohort Study

Antibiotics ◽

10.3390/antibiotics10030340 ◽

2021 ◽

Vol 10 (3) ◽

pp. 340

Author(s):

Raquel Bandeira da Silva ◽

Mauro José Salles

Keyword(s):

Risk Factors ◽

Treatment Failure ◽

Treatment Outcomes ◽

Revision Arthroplasty ◽

Multidrug Resistant ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Postoperative Hematoma ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

Gram-negative bacteria (GNB), including multidrug-resistant (MDR) pathogens, are gaining importance in the aetiology of prosthetic joint infection (PJI). This retrospective observational study identified independent risk factors (RFs) associated with MDR-GNB PJI and their influence on treatment outcomes. We assessed MDR bacteria causing hip and knee PJIs diagnosed at a Brazilian tertiary hospital from January 2014 to July 2018. RFs associated with MDR-GNB PJI were estimated by bivariate and multivariate analyses using prevalence ratios (PRs) with significance at p < 0.05. Kaplan–Meier analysis was performed to evaluate treatment outcomes. Overall, 98 PJI patients were analysed, including 56 with MDR-GNB and 42 with other bacteria. Independent RFs associated with MDR-GNB PJI were revision arthroplasty (p = 0.002), postoperative hematoma (p < 0.001), previous orthopaedic infection (p = 0.002) and early infection (p = 0.001). Extensively drug-resistant GNB (p = 0.044) and comorbidities (p = 0.044) were independently associated with MDR-GNB PJI treatment failure. In sum, MDR-GNB PJI was independently associated with previous orthopaedic surgery, postoperative local complications and pre-existing infections and was possibly related to selective pressure on bacterial skin colonisation by antibiotics prescribed for early PJI. Infections due to MDR-GNB and comorbidities were associated with higher treatment failure rates.

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