scholarly journals Deep infection after hip hemiarthroplasty: risk factors for infection and outcome of treatments

2021 ◽  
Vol 2 (11) ◽  
pp. 958-965
Author(s):  
Simon Craxford ◽  
Ben A. Marson ◽  
Jessica Nightingale ◽  
Adeel Ikram ◽  
Yuvraj Agrawal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Joint Infection ◽  
Binary Logistic Regression ◽  
Deep Infection ◽  
Success Rates ◽  
Implant Retention ◽  
Cemented Arthroplasty ◽  
Deep Surgical Site Infection ◽  
One Year ◽  
Excision Arthroplasty

Aims Deep surgical site infection (SSI) remains an unsolved problem after hip fracture. Debridement, antibiotic, and implant retention (DAIR) has become a mainstream treatment in elective periprosthetic joint infection; however, evidence for DAIR after infected hip hemiarthroplaty is limited. Methods Patients who underwent a hemiarthroplasty between March 2007 and August 2018 were reviewed. Multivariable binary logistic regression was performed to identify and adjust for risk factors for SSI, and to identify factors predicting a successful DAIR at one year. Results A total of 3,966 patients were identified. The overall rate of SSI was 1.7% (51 patients (1.3%) with deep SSI, and 18 (0.45%) with superficial SSI). In all, 50 patients underwent revision surgery for infection (43 with DAIR, and seven with excision arthroplasty). After adjustment for other variables, only concurrent urinary tract infection (odds ratio (OR) 2.78, 95% confidence interval (CI) 1.57 to 4.92; p < 0.001) and increasing delay to theatre for treatment of the fracture (OR 1.31 per day, 95% CI 1.12 to 1.52; p < 0.001) were predictors of developing a SSI, while a cemented arthroplasty was protective (OR 0.54, 95% CI 0.31 to 0.96; p = 0.031). In all, nine patients (20.9%) were alive at one year with a functioning hemiarthroplasty following DAIR, 20 (46.5%) required multiple surgical debridements after an initial DAIR, and 18 were converted to an excision arthroplasty due to persistent infection, with six were alive at one year. The culture of any gram-negative organism reduced success rates to 12.5% (no cases were successful with methicillin-resistant Staphylococcus aureus or Pseudomonas infection). Favourable organisms included Citrobacter and Proteus (100% cure rate). The all-cause mortality at one year after deep SSI was 55.87% versus 24.9% without deep infection. Conclusion Deep infection remains a devastating complication regardless of the treatment strategy employed. Success rates of DAIR are poor compared to total hip arthroplasty, and should be reserved for favourable organisms in patients able to tolerate multiple surgical procedures. Cite this article: Bone Jt Open 2021;2(11):958–965.

scholarly journals Comparison of the success rate after debridement, antibiotics and implant retention (DAIR) for periprosthetic joint infection among patients with or without a sinus tract

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Wang Deng ◽  
Rui Li ◽  
Hongyi Shao ◽  
Baozhan Yu ◽  
Jiying Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Success Rate ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Sinus Tract ◽  
Success Rates ◽  
Implant Retention ◽  
Potential Risk Factors

Abstract Background The relevance between the presence of a sinus tract and the failure risk after debridement, antibiotics and implant retention (DAIR) for periprosthetic joint infection (PJI) after hip or knee arthroplasty is still unclear. This study aimed to compare the success rate of DAIR between patients with or without a sinus tract and to explore the possible risk factors for failure after DAIR in patients with a sinus tract. Methods Consecutive DAIR cases for PJI after hip or knee arthroplasty between January 2009 and June 2019 with a minimum 1-year follow-up in two tertiary joint arthroplasty centers were included. Patients were classified into the sinus tract group and the non-sinus tract group according to the presence of a sinus tract. The success rate after DAIR were compared using Kaplan-Meier survival analysis. Potential risk factors for failure in the sinus group were also explored. Results One hundred seven patients were included. At a median 4.4 years of follow-up, 19 of 52 (36.5%) cases failed in the sinus tract group, while 15 of 55 (27.3%) cases failed in the non-sinus tract group. The 1-year and 5-year cumulative success rates were 71.2% (95% confidence interval (CI): 59.8-84.6%) and 56.8% (95% CI: 42.6-75.7%) in the sinus tract group, respectively, which were similar to the counterparts in the non-sinus tract group (P = 0.214). Among patients with a sinus tract, DAIR with the exchange of modular components showed a higher success rate (75.8% versus 47.4%, P = 0.038). Conclusions The presence of a sinus tract does not affect the success rate of DAIR. Modular component exchange in DAIR was proposed for patients with a sinus tract for an improved infection control rate.

scholarly journals Treatment of Prosthetic Joint Infection with Debridement, Antibiotics and Irrigation with Implant Retention - a Narrative Review

2018 ◽  
Vol 3 (3) ◽  
pp. 108-117 ◽  
Author(s):  
Ricardo Sousa ◽  
Miguel Araújo Abreu
Keyword(s):  
Surgical Technique ◽  
Prosthetic Joint Infection ◽  
Gold Standard ◽  
Selection Criteria ◽  
Joint Infection ◽  
Narrative Review ◽  
Success Rates ◽  
Prosthetic Joint ◽  
Implant Retention ◽  
Patient Selection Criteria

Abstract. Prosthetic joint infection usually requires combined medical and surgical therapy. While revision surgery is widely considered to be the gold standard surgical procedure, debridement, antibiotics and irrigation with implant retention is a very appealing alternative.There is however great controversy regarding its real worth with success rates ranging from 0% to over 90%. A number of different patient and host related variables as well as specific aspects of surgical and medical management have been described as relevant for the final outcome.Along this paper, the authors will provide the readers with a critical narrative review of the currently available literature while trying to provide concise and practical treatment recommendations regarding adequate patient selection criteria, proper surgical technique and optimal antibiotic therapy.

Bacteriology and Risk Factors for Development of Late (Greater Than One Year) Deep Infection Following Spinal Fusion With Instrumentation

2014 ◽  
Vol 2 (3) ◽  
pp. 186-190 ◽  
Author(s):  
Jaren LaGreca ◽  
Mark Hotchkiss ◽  
Patrick Carry ◽  
Kevin Messacar ◽  
Ann-Christine Nyquist ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Fusion ◽  
Deep Infection ◽  
One Year

scholarly journals REDUCED INFECTION RATE AFTER ASEPTIC REVISION TOTAL HIP ARTHROPLASTY WITH EXTENDED ORAL ANTIBIOTIC PROTOCOL

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Amer Mohiuddin, BS ◽  
Justin Rice, BA ◽  
Mary Ziemba-Davis, BA ◽  
R. Michael Meneghini, MD
Keyword(s):  
Total Hip Arthroplasty ◽  
Infection Rate ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Deep Infection ◽  
Oral Antibiotic ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Aseptic Revision ◽  
One Year

Background and Hypothesis: Periprosthetic joint infection (PJI is a leading cause of failure after aseptic revision total hip arthroplasty (RTHA). While well documented in the primary setting, perioperative antibiotic duration is not well described in RTHA where the risk of PJI was recently reported to be 8% one-year post-revision. The study purpose was to evaluate whether extended oral antibiotic prophylactic protocol minimizes PJI in aseptic RTHA patients compared to the published literature.   Project Methods: 169 consecutive aseptic RTHAs performed with modern perioperative and infection-prevention protocols by a single surgeon at a single center were retrospectively reviewed. 80% of patients were discharged on 7-day oral antibiotic prophylaxis while intra-operative cultures were incubating. Infections and reoperations were documented.   Results: Average age and BMI were 63 years and 30 kg/m2.  67% percent of patients were ASA-III/IV, signifying the severity of comorbidities in this revision cohort. There we no cases of PJI in the 90-day postoperative period. Ninety-eight percent of cases were infection free at mean follow-up of 45 months. Three (1.8%) cases underwent reoperation for deep infection at 110, 161 and 581 days.    Conclusion and Potential Impact: Our observed infection rate of 0.0% is lower than published infection rates following RTHA and a 1.5% infection rate in primary THA in patients with no identifiable risk factors for PJI.  Based on this clinically meaningful decrease in PJI in this challenging cohort, we encourage further study regarding extended antibiotic protocol weighed appropriately against potential consequences.   

scholarly journals Repeat two-stage exchange arthroplasty for recurrent periprosthetic hip or knee infection: what are the chances for success?

2022 ◽  
Author(s):  
A. C. Steinicke ◽  
J. Schwarze ◽  
G. Gosheger ◽  
B. Moellenbeck ◽  
T. Ackmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Rank Test ◽  
Success Rates ◽  
Two Stage ◽  
Second Stage ◽  
Exchange Arthroplasty ◽  
Parametric Testing

Abstract Introduction Two-stage revision is a frequently chosen approach to treat chronic periprosthetic joint infection (PJI). However, management of recurrent infection after a two-stage exchange remains debated and the outcome of a repeat two-stage procedure is unclear. This study investigates the success rates of repeat two-stage exchange arthroplasty and analyzes possible risk factors for failure. Materials and methods We retrospectively identified 55 patients (23 hips, 32 knees) who were treated with repeat resection arthroplasty and planned delayed reimplantation for recurrent periprosthetic joint infection between 2010 and 2019 after a prior two-stage revision at the same institution. The minimum follow-up was 12 months with a median follow-up time of 34 months (IQR 22–51). The infection-free survival, associated revision surgeries, and potential risk factors for further revision were analyzed using Kaplan–Meier survival curves and comparative non-parametric testing. Results 78% (43/55) underwent reimplantation after a repeat implant removal. Of those who completed the second-stage surgery, 37% (16/43) underwent additional revision for infection and 14% (6/55) underwent amputation. The reinfection-free implant survivorship amounted to 77% (95% CI 64–89%) after 1 year and 38% (95% CI 18–57%) after 5 years. Patients with a higher comorbidity score were less likely to undergo second-stage reimplantation (median 5 vs. 3, p = 0.034). Furthermore, obese patients (p = 0.026, Fisher’s exact test) and diabetics (p < 0.001, log-rank test) had a higher risk for further infection. Most commonly cultures yielded polymicrobial growth at the repeat two-stage exchange (27%, 15/55) and at re-reinfection (32%, 9/28). Pathogen persistence was observed in 21% (6/28) of re-reinfected patients. Conclusion The success rates after repeat two-stage exchange arthroplasty are low. Patients must be counseled accordingly and different modes of treatment should be considered.

scholarly journals Mycoplasma pneumoniae and Recurrent Respiratory Tract Infection Within One Year After Treatment in Infants: Risk Factors and Prevalence

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Cheng-Yi Wang ◽  
Chao-Min Song ◽  
Guang-Hua Liu
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Respiratory Tract ◽  
Mycoplasma Pneumoniae ◽  
Significant Risk ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
History Of ◽  
One Year ◽  
Tract Infections

Background: Mycoplasma pneumoniae pneumonia (MPP) is common in pediatric patients. Many studies showed that recurrent respiratory tract infections (RRTIs) are common in the year following treatment of MPP in infants, but the factors associated with the occurrence of RRTIs are rarely reported. Therefore, the present study aimed to identify these factors. Methods: This retrospective observational study included infants (< one year) who were clinically treated for MPP from January 2015 to December 2018. Clinical features and relevant data were collected on admission. The cases of the occurrence of RRTIs and the presence of related factors after one year of follow-up were investigated by questionnaires. The questionnaires contained the number of upper respiratory infections, tracheobronchitis, and pneumonia, the titers and course of MP-IgG and positive IgM antibody, eczema, pet ownership, interior decoration, inhaled or ingested allergens, exposure to environmental tobacco smoke, and gastrointestinal function. Independent significant risk factors for RRTIs were identified using binary logistic regression. Results: A total of 300 MPP cases were included, among which RRTIs occurred in 134 (44.7%) cases in the year following MPP treatment. Binary logistic regression analysis showed that a history of prematurity (OR = 6.336, 95% CI: 2.337 - 17.116, P ≤ 0.001), a history of exposure to inhaled or ingested allergens (OR = 2.527, 95% CI: 1.289 - 4.956, P = 0.007), and co-infection involving Chlamydia pneumoniae (OR = 2.787, 95% CI: 1.145 - 6.784, P = 0.024) were significantly and positively associated with RRTIs after MPP, while age (OR = 0.894, 95% CI: 0.825 - 0.970, P = 0.007) showed a negative correlation with RRTIs. Conclusions: RRTIs in the year following clinical treatment of MPP in infants are relatively common and significantly associated with the patient’s age, history of prematurity, history of exposure to inhaled or ingested allergens, and C. pneumoniae co-infection. Thus, these factors should be carefully assessed in pediatric MPP cases to predict the risk of RRTIs and appropriately manage the patient.

scholarly journals Success of Debridement and Implant Retention for Periprosthetic Joint Infection in TKA – Does The Surgeon Matter?

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0020
Author(s):  
Simon W Young ◽  
Mark Zhu ◽  
Saiprasad Ravi ◽  
Richard Cowley ◽  
Chris Luey
Keyword(s):  
Multivariate Analysis ◽  
Lower Limb ◽  
Joint Infection ◽  
Treatment Success ◽  
Univariate Analysis ◽  
First Episode ◽  
Success Rates ◽  
Factors Affecting ◽  
Prosthetic Joint ◽  
Implant Retention

Introduction: Prosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). In acute haematogenous and early post-operative PJI, debridement and implant retention (DAIR) is often the initial treatment and reported success rates vary. The aim of this study was to identify factors affecting the success of DAIR and in particular whether involvement of a lower limb arthroplasty surgeon (LLA) can affect outcome. Method: In a multicentre review over a 15 year period we identified 137 patients undergoing DAIR for first episode PJI following primary TKA at one of three tertiary hospitals. Patients receiving arthroscopic washouts, culture negative PJI, and previous PJIs were excluded. Data on patient, hospital, and surgical factors were identified including age of implant, time to theatre, presence of gross purulence, bacterial subtype, inflammatory markers, relevant comorbidities, whether modular component exchange was performed, and whether a lower limb arthroplasty surgeon performed the procedure. Treatment success was defined as infection eradication characterized by no clinical failure (healed wound and painless joint) or infection recurrence, and no mortality or further surgery due to PJI within minimum two-year follow up post DAIR. Multivariate analysis was performed using a logistic regression model to identify factors associated with successful DAIR. Results: Overall failure rate of DAIR in TKA was 42%. A specialist arthroplasty surgeon was present in 49% of cases. Arthroplasty surgeons performed modular exchange in 92% of cases compared to 57% for other surgeons (RR1.6, P <0.01). On multivariate analysis, involvement of a specialist arthroplasty surgeon was the only factor associated with a significant increase in success of DAIR (OR 2.94, P=0.01). Age of prosthesis less than 90 days and the lack of macroscopic purulence (OR 2.44, p=0.04) increased DAIR success on univariate analysis only. Conclusions: Involvement of a specialist arthroplasty surgeon was associated with a 2.9 times higher success rate for DAIR in TKA. Specialist arthroplasty surgeons were more likely to perform modular exchange. This study suggests surgical technique and thorough debridement is likely to be important to the success of DAIR in TKA.

scholarly journals Antimicrobial-Related Severe Adverse Events during Treatment of Bone and Joint Infection Due to Methicillin-Susceptible Staphylococcus aureus

2013 ◽  
Vol 58 (2) ◽  
pp. 746-755 ◽  
Author(s):  
Florent Valour ◽  
Judith Karsenty ◽  
Anissa Bouaziz ◽  
Florence Ader ◽  
Michel Tod ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Adverse Events ◽  
Joint Infection ◽  
Binary Logistic Regression ◽  
Chronic Arthritis ◽  
High Rate ◽  
Content Type ◽  
Joint Infections ◽  
Severe Adverse Events

ABSTRACTProlonged antimicrobial therapy is recommended for methicillin-susceptibleStaphylococcus aureus(MSSA) bone and joint infections (BJI), but its safety profile and risk factors for severe adverse events (SAE) in clinical practice are unknown. We addressed these issues in a retrospective cohort study (2001 to 2011) analyzing antimicrobial-related SAE (defined according to the Common Terminology Criteria for Adverse Events) in 200 patients (male, 62%; median age, 60.8 years [interquartile range {IQR}, 45.5 to 74.2 years]) with MSSA BJI admitted to a reference regional center with acute (66%) or chronic arthritis (7.5%), osteomyelitis (9.5%), spondylodiscitis (16%), or orthopedic device-related infections (67%). These patients received antistaphylococcal therapy for a median of 26.6 weeks (IQR, 16.8 to 37.8 weeks). Thirty-eight SAE occurred in 30 patients (15%), with a median time delay of 34 days (IQR, 14.75 to 60.5 days), including 10 patients with hematologic reactions, 9 with cutaneomucosal reactions, 6 with acute renal injuries, 4 with hypokalemia, and 4 with cholestatic hepatitis. The most frequently implicated antimicrobials were antistaphylococcal penicillins (ASP) (13 SAE/145 patients), fluoroquinolones (12 SAE/187 patients), glycopeptides (9 SAE/101 patients), and rifampin (7 SAE/107 patients). Kaplan-Meier curves and stepwise binary logistic regression analyses were used to determine the risk factors for the occurrence of antimicrobial-related SAE. Age (odds ratio [OR], 1.479 for 10-year increase; 95% confidence interval [CI], 1.116 to 1.960;P= 0.006) appeared to be the only independent risk factor for SAE. In patients receiving ASP or rifampin, daily dose (OR, 1.028; 95% CI, 1.006 to 1.051;P= 0.014) and obesity (OR, 8.991; 95% CI, 1.453 to 55.627;P= 0.018) were associated with the occurrence of SAE. The high rate of SAE and their determinants highlighted the importance of the management and follow-up of BJI, with particular attention to be paid to older persons, especially for ASP dosage, and to rifampin dose adjustment in obese patients.

Sign in / Sign up

Export Citation Format

Share Document