scholarly journals Analysis Of The KLIC-score; An Outcome Predictor Tool For Prosthetic Joint Infections Treated With Debridement, Antibiotics And Implant Retention

2018 ◽  
Vol 3 (3) ◽  
pp. 150-155 ◽  
Author(s):  
Sean DX Duffy ◽  
Nathanael Ahearn ◽  
Elizabeth SR Darley ◽  
Andrew J Porteous ◽  
James R Murray ◽  
...  
Keyword(s):  
Joint Infection ◽  
Primary Treatment ◽  
Knee Prostheses ◽  
Early Failure ◽  
Joint Infections ◽  
Primary Treatment Modality ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Risk Stratification Tool ◽  
Implant Retention

Abstract. Background: Debridement, antibiotics and implant retention (DAIR) forms the primary treatment modality for early prosthetic joint infection (PJI). The KLIC score has been proposed as a risk stratification tool for use in predicting outcome of prosthetic knee infections. Our aim was to determine the accuracy of this scoring system at an independent tertiary PJI centre in a typical DAIR population.Methods: Between 2008 and 2015, patients with infected knee prostheses treated with DAIR were identified. The patient notes and blood tests were reviewed retrospectively and the 'KLIC-score' was calculated and correlated with outcome. The end point for early failure was defined as: 1) the need for unscheduled surgery, 2) infection-related death ≤12 months from debridement or 3) the need for suppressive antibiotic treatment.Results: 59 patients received DAIR procedures for knee PJI. Treatment was successful in 41 patients (69%) with early failure in 18 patients (31%). Patients deemed high-risk (KLIC-score ≥7) had notably higher failure rates (60%) than those scoring <7 (28%). No relationship can be drawn between KLIC-scores of <7 and failure rates.Conclusions: The KLIC-score applied retrospectively was able to predict patients with the highest risk of early failure but provides little information in patients with scores of <7.

scholarly journals Do Prosthetic Joint Infections Worsen the Functional Ambulatory Outcome of Patients with Joint Replacements? A Retrospective Matched Cohort Study

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 872
Author(s):  
Isabel Mur ◽  
Marcos Jordán ◽  
Alba Rivera ◽  
Virginia Pomar ◽  
José Carlos González ◽  
...  
Keyword(s):  
Cohort Study ◽  
Joint Infection ◽  
Assistive Device ◽  
Matched Cohort ◽  
Knee Prostheses ◽  
Matched Cohort Study ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Hip Arthroplasties

Objectives: To assess the effect on the functional ambulatory outcome of postoperative joint infection (PJI) cured at the first treatment attempt versus not developing PJI in patients with hip and knee prostheses. Methods: In a single-hospital retrospectively matched cohort study, each patient with PJI between 2007 and 2016 was matched on age, sex, type of prosthesis and year of implantation with two other patients with uninfected arthroplasties. The definition of a PJI cure included infection eradication, no further surgical procedures, no PJI-related mortality and no suppressive antibiotics. Functional ambulatory status evaluated one year after the last surgery was classified into four simple categories: able to walk without assistance, able to walk with one crutch, able to walk with two crutches, and unable to walk. Patients with total hip arthroplasties (THAs), total knee arthroplasties (TKAs) and partial hip arthroplasties (PHAs) were analysed separately. Results: A total of 109 PJI patients (38 TKA, 41 THA, 30 PHA) and 218 non-PJI patients were included. In a model adjusted for clinically relevant variables, PJI was associated with a higher risk of needing an assistive device for ambulation (vs. walking without aid) among THA (adjusted odds ratio (OR) 3.10, 95% confidence interval (95% CI) 1.26–7.57; p = 0.014) and TKA patients (OR 5.40, 95% CI 2.12–13.67; p < 0.001), and with requiring two crutches to walk or being unable to walk (vs. walking unaided or with one crutch) among PHA patients (OR 3.05, 95% CI 1.01–9.20; p = 0.047). Conclusions: Ambulatory outcome in patients with hip and knee prostheses with postoperative PJI is worse than in patients who do not have PJI.

scholarly journals KLIC-score for predicting early failure in prosthetic joint infections treated with debridement, implant retention and antibiotics

2015 ◽  
Vol 21 (8) ◽  
pp. 786.e9-786.e17 ◽  
Author(s):  
E. Tornero ◽  
L. Morata ◽  
J.C. Martínez-Pastor ◽  
G. Bori ◽  
C. Climent ◽  
...  
Keyword(s):  
Early Failure ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Implant Retention

scholarly journals 381. Clinical Outcome of Polymicrobial Prosthetic Joint Infection Managed with Debridement, Antibiotics, and Implant Retention (DAIR)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S198-S198
Author(s):  
Babak Hooshmand ◽  
Dima Youssef ◽  
Kathleen M Riederer ◽  
Susan M Szpunar ◽  
Ashish Bhargava
Keyword(s):  
Joint Infection ◽  
Surgical Site Infections ◽  
International Classification Of Diseases ◽  
Implant Removal ◽  
Suppressive Therapy ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Implant Retention

Abstract Background Polymicrobial (PM) prosthetic joint infections (PJIs) account for 4% to 37% of all PJIs. There is limited literature on surgical debridement, antibiotics and implant retention (DAIR) in PMPJIs. We aimed to assess clinical outcomes of PMPJIs managed with DAIR. Methods A retrospective cohort was studied at three Ascension hospitals in Detroit from January 2012 to December 2018. Cases were identified using the International Classification of Diseases, 9th and 10th Revision code specific for PJIs. Patient’s electronic medical records were reviewed. Results Twenty-six PMPJIs managed with DAIR were identified. Mean age of the infected patients was 66 years. 18 (69%) patients were female and 19 (73%) were caucasians. Infected sites were hip in 15 (58%), knee in 10 (38%) and ankle in 1 (4%) patient. 22 (85%) patients had osteoarthritis, 3 (12%) had diabetes, 3 (12%) were on steroids and 1 (4%) had rheumatoid arthritis. Symptom onset of less than a week was noted in 14 (58%) and 3 or more weeks in 8 (31%) patients. Pain, swelling and drainage were present in 21 (81%), 13 (50%) and 18 (69%) cases. Fever on admission was noted in 7 (27%) patients. 11 (42%) patients were re-admitted in the following 12 months after DAIR. 2 (19%) patients developed superficial surgical site infection (SSI) while 9 (81%) had deep SSI. Implant removal was needed in 6 (55%) patients. 5 (2 superficial and 3 deep) patients required further debridement and antibiotics. 5 (19%) had good outcome with 3–6 months of antibiotics. 3 (12%) patients required long-term chronic suppressive therapy. One patient died from a cardiac event during follow-up. Conclusion In our study, PMPJIs managed with DAIR had high readmission rates and deep surgical site infections. DAIR failure, noted in 23% of our cases, required implant removal within 12 months of follow-up. Disclosures All authors: No reported disclosures.

scholarly journals Clinical and Microbiological Characteristics of Bacteroides Prosthetic Joint Infections

2017 ◽  
Vol 2 (3) ◽  
pp. 122-126 ◽  
Author(s):  
Neel Shah ◽  
Douglas Osmon ◽  
Aaron J. Tande ◽  
James Steckelberg ◽  
Rafael Sierra ◽  
...  
Keyword(s):  
Joint Infection ◽  
Significant Proportion ◽  
Resection Arthroplasty ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Microbiological Characteristics ◽  
Prosthetic Joint Infections ◽  
Implant Retention ◽  
History Of

Abstract. Clinical and microbiological characteristics of patients with Bacteroides prosthetic joint infection (PJI) have not been well described in the literature. The aim of this retrospective cohort study was to assess the outcome of patients with Bacteroides PJI and to review risk factors associated with failure of therapy. Between 1/1969 and 12/2012, 20 episodes of Bacteroides PJI in 17 patients were identified at our institution. The mean age of the patients in this cohort at the time of diagnosis was 55.6 years; 59% (n=10) had knee involvement. Twenty four percent (n=4) had diabetes mellitus, and 24% had a history of either gastrointestinal (GI) or genitourinary (GU) pathology prior to the diagnosis of PJI. Thirty five percent (n=6) were immunosuppressed. The initial medical/surgical strategy was resection arthroplasty (n=9, 50%) or debridement and implant retention (n=5, 28%). Thirty seven percent (n=7) were treated with metronidazole. Eighty percent (n=4) of patients that failed therapy had undergone debridement and retention of their prosthesis, as compared to none of those treated with resection arthroplasty. Seventy percent (n=14) of patient episodes were infection free at their last date of follow up. In conclusion, a significant proportion of patients with Bacteroides PJI are immunosuppressed and have an underlying GI or GU tract pathology. Retention and debridement of the prosthesis is associated with a higher risk of treatment failure.

scholarly journals Chronic Antibiotic Suppression for Nonstaphylococcal Prosthetic Joint Infections Treated with Debridement or Implant Retention

2021 ◽  
Vol 1 (S1) ◽  
pp. s3-s4
Author(s):  
Poorani Sekar ◽  
Rajeshwari Nair ◽  
Brice Beck ◽  
Bruce Alexander ◽  
Kelly Miell ◽  
...  
Keyword(s):  
Joint Infection ◽  
Antimicrobial Treatment ◽  
Oral Antibiotics ◽  
Musculoskeletal Infection ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Implant Retention ◽  
Cas A ◽  
Va Hospitals

Background: Early postoperative and acute prosthetic joint infection (PJI) may be managed with debridement, antibiotics, and implant retention (DAIR). Among patients with nonstaphylococcal PJI, an initial 4–6-week course of intravenous or highly bioavailable oral antibiotics is recommended in the Infectious Diseases Society of America (IDSA) guidelines, with disagreement among committee members on the need for subsequent chronic oral antimicrobial suppression (CAS). We aimed to characterize patients with nonstaphylococcal PJI who received CAS and to compare them to those who did not receive CAS. Methods: This retrospective cohort study included patients admitted to Veterans’ Affairs (VA) hospitals from 2003 to 2017 who had a PJI caused by nonstaphylococcal bacteria, underwent DAIR, and received 4–6 weeks of antimicrobial treatment. PJI was defined by Musculoskeletal Infection Society (MSIS) 2011 criteria. CAS was defined as at least 6 months of oral antibiotics following initial treatment of the PJI. Patients were followed for 5 years after debridement. We used χ2 tests and t tests were used to compare patients who received CAS with those who did not receive CAS. Results: Overall, 561 patients had a nonstaphylococcal PJI treated with DAIR, and 80.6% of patients received CAS. The most common organisms causing PJI were streptococci. We detected no significant differences between patients who received CAS and those who did not receive CAS, except that modified Acute Physiology and Chronic Health Evaluation (mAPACHE) scores were higher among patients who did not receive CAS (Table 1). Conclusion: Patients not on CAS were more severely ill (by mAPACHE) than those on CAS. Otherwise, the 2 groups were not different. This finding was contrary to our hypothesis that patients with multiple comorbidities or higher mAPACHE scores would be more likely to get CAS. A future analysis will be conducted to assess treatment failure in both groups. We hope to find a specific cohort who may benefit from CAS and hope to deimplement CAS in others who may not benefit from it.Funding: NoDisclosures: None

scholarly journals Vancomycin-Rifampin Combination Therapy Has Enhanced Efficacy against an Experimental Staphylococcus aureus Prosthetic Joint Infection

2013 ◽  
Vol 57 (10) ◽  
pp. 5080-5086 ◽  
Author(s):  
Jared A. Niska ◽  
Jonathan H. Shahbazian ◽  
Romela Irene Ramos ◽  
Kevin P. Francis ◽  
Nicholas M. Bernthal ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Combination Therapy ◽  
Mouse Model ◽  
Antibiotic Therapy ◽  
Joint Infection ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Implant Retention

ABSTRACTTreatment of prosthetic joint infections often involves a two-stage exchange, with implant removal and antibiotic spacer placement followed by systemic antibiotic therapy and delayed reimplantation. However, if antibiotic therapy can be improved, one-stage exchange or implant retention may be more feasible, thereby decreasing morbidity and preserving function. In this study, a mouse model of prosthetic joint infection was used in whichStaphylococcus aureuswas inoculated into a knee joint containing a surgically placed metallic implant extending from the femur. This model was used to evaluate whether combination therapy of vancomycin plus rifampin has increased efficacy compared with vancomycin alone against these infections. On postoperative day 7, vancomycin with or without rifampin was administered for 6 weeks with implant retention.In vivobioluminescence imaging,ex vivoCFU enumeration, X-ray imaging, and histologic analysis were carried out. We found that there was a marked therapeutic benefit when vancomycin was combined with rifampin compared with vancomycin alone. Taken together, our results suggest that the mouse model used could serve as a valuablein vivopreclinical model system to evaluate and compare efficacies of antibiotics and combinatory therapy for prosthetic joint infections before more extensive studies are carried out in human subjects.

scholarly journals Treatment of <i>Neisseria meningitidis</i> prosthetic joint infections with short-course antibiotics: three cases and a literature review

2020 ◽  
Vol 6 (2) ◽  
pp. 33-37
Author(s):  
Sarah Browning ◽  
Harry N. Walker ◽  
Thomas Ryan ◽  
Robert Pickles ◽  
Michael Loftus ◽  
...  
Keyword(s):  
Literature Review ◽  
Neisseria Meningitidis ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Short Course ◽  
Prosthetic Joint Infections ◽  
Implant Retention

Abstract. Neisseria meningitidis is a rare cause of prosthetic joint infection (PJI), with only three cases previously reported. Here we report three further cases, all of which were successfully treated with implant retention and short-course antibiotics (<6 weeks).

scholarly journals Mid-term follow-up results after implementing a new strategy for the diagnosis and management of periprosthetic joint infections

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rares Mircea Birlutiu ◽  
Manuela Mihalache ◽  
Patricia Mihalache ◽  
Razvan Silviu Cismasiu ◽  
Victoria Birlutiu
Keyword(s):  
Joint Infection ◽  
Published Data ◽  
Survival Percentage ◽  
Joint Infections ◽  
Kaplan Meier ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
New Strategy ◽  
Implant Retention

Abstract Background Periprosthetic joint infections (PJIs) represent one of the most serious complications associated with joint replacement surgeries, a complication also of modern orthopedic surgery despite the efforts that occurred in this field. Frequently PJIs lead to prolonged morbidity, increased costs and mortality. Methods We are conducting a single-center observational cohort ongoing study in the Academic Emergency Hospital Sibiu, Romania, study in which sonication of the retrieved and as a rapid method of bacteria detection, molecular identification of bacteria by 16S rRNA beacon-based fluorescent in situ hybridization (bbFISH) are used. Results A total of 61 patients were enrolled in this study. The diagnosis of aseptic loosening was established in 30 cases (49.1%) and the diagnosis of periprosthetic joint infection was established at 31 patients (50.8%). The mean follow-up period in the subgroup of patients diagnosed with periprosthetic joint infections was 36.06 ± 12.59 months (range: 1–54). The 25-months Kaplan-Meier survival rate as the end point, as a consequence of the period of enrollment and a different follow-up period for each type of surgical procedure, was 75% after debridement and implant retention, 91.7% after one-stage exchange, 92.3% after two-stage exchange, and 100% after three-stage exchange. There were no significant differences in survival percentage. Conclusions Our study has good results similar to previously published data. We cannot recommend one strategy of managing prosthetic joint infections over the other. Definitely, there is a need for prospective randomized controlled trials.

scholarly journals Outcome of debridement, antibiotics and implant retention for staphylococcal hip and knee prosthetic joint infections, focused on rifampicin use: a systematic review and meta-analysis

2021 ◽  
Author(s):  
H Scheper ◽  
L M Gerritsen ◽  
B G Pijls ◽  
S A Van Asten ◽  
L G Visser ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Joint Infection ◽  
Success Rates ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Implant Retention ◽  
Important Evidence

Abstract The treatment of staphylococcal prosthetic joint infection (PJI) with debridement, antibiotics and retention of the implant (DAIR) often results in failure. An important evidence gap concerns the treatment with rifampicin for PJI. A systematic review and meta-analysis were conducted to assess the outcome of staphylococcal hip and/or knee PJI after DAIR, focused on the role of rifampicin. Studies published until September 2nd, 2020 were included. Success rates were stratified for type of joint and type of micro-organism. Sixty-four studies were included. The pooled risk ratio for rifampicin effectiveness was 1.10 (95% CI 1.00-1.22). Pooled success rate was 69% for S. aureus hip PJI, 54% for S. aureus knee PJI, 83% for CNS hip PJI and 73% for CNS knee PJI. Success rates for MRSA PJI (58%) were similar to MSSA PJI (60%). The meta-analysis indicates that rifampicin may only prevent a small fraction of all treatment failures.

scholarly journals Pseudomonas Prosthetic Joint Infections: A Review of 102 Episodes

2016 ◽  
Vol 1 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Neel B. Shah ◽  
Douglas R. Osmon ◽  
James M. Steckelberg ◽  
Rafael J. Sierra ◽  
Randall C. Walker ◽  
...  
Keyword(s):  
Joint Infection ◽  
High Failure Rate ◽  
Cumulative Survival ◽  
Factors Associated ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Implant Retention ◽  
History Of ◽  
The Mean

Abstract. Background: The outcome of patients with Pseudomonas prosthetic joint infection (PS PJI) has not been well studied. The aim of this retrospective cohort study was to assess the outcome of patients with Pseudomonas PJI and to review risk factors associated with failure of therapy.Methods: Between 1/1969 and 12/2012, 102 episodes of PS PJI in 91 patients were identified.Results: The mean age at the time of diagnosis was 67.4 years; forty three percent had knee involvement. Over 40 percent had either diabetes mellitus or a history of gastrointestinal or genitourinary surgery. Nearly half (48 out of 102 episodes) received aminoglycoside monotherapy, while 25% received an anti-pseudomonal cephalosporin. The 2-year cumulative survival free from failure was 69% (95% CI, 56%-82%). Patients treated with resection arthroplasty, two-stage exchange, and debridement with implant retention had a 2-year cumulative survival free from failure of 80% (95% CI, 66%-95%), 83% (95% CI, 60%-100%), and 26% (95% CI, 23%-29%) respectively (P=0.0001).Conclusions: PS PJI's are associated with a high failure rate. Patients treated with debridement and implant retention had a worse outcome.

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