RT Journal Article
T1 Lower Success Rate of Débridement and Implant Retention in Late Acute versus Early Acute Periprosthetic Joint Infection Caused by Staphylococcus spp. Results from a Matched Cohort Study.
A1 Wouthuyzen-Bakker, Marjan
A1 Sebillotte, Marine
A1 Huotari, Kaisa
A1 Escudero-Sanchez, Rosa
A1 Benavent, Eva
A1 Parvizi, Javad
A1 Fernandez-Sampedro, Marta
A1 Barbero, Jose Maria
A1 Garcia-Cañete, Joaquin
A1 Trebse, Rihard
A1 Del Toro, Maria
A1 Diaz-Brito, Vicens
A1 Sanchez, Marisa
A1 Scarborough, Matthew
A1 Soriano, Alex
K1 Debridement
K1 Joint Prosthesis
K1 Prosthesis-Related Infections
K1 Risk Factors
K1 Time Factors
AB Background Surgical débridement , antibiotics and implant retention (DAIR) is currently recommended by international guidelines for both early acute (postsurgical) and late acute (hematogenous) periprosthetic joint infections (PJIs). However, due to a different pathogenesis of infection , a different treatment strategy may be needed. Questions/purposes (1) Compared with early acute PJIs, are late acute PJIs associated with a higher risk of DAIR failure? (2) When stratified by microorganism, is the higher risk of failure in late acute PJI associated with Staphylocococcus aureus infection ? (3) When analyzing patients with S. aureus infection , what factors are independently associated with DAIR failure? Methods In this multicenter observational study , early acute and late acute PJIs treated with DAIR were retrospectively evaluated and matched according to treating center, year of diagnosis , and infection -causing microorganism. If multiple matches were available, the early acute PJI diagnosed closest to the late acute PJI was selected. A total of 132 pairs were included. Treatment success was defined as a retained implant during follow-up without the need for antibiotic suppressive therapy . Results Late acute PJIs had a lower treatment success (46% [60 of 132]) compared with early acute PJIs (76% [100 of 132]), OR 3.9 [95% CI 2.3 to 6.6]; p < 0.001), but the lower treatment success of late acute PJIs was only observed when caused by Staphylococcus spp (S. aureus: 34% versus 75%; p < 0.001; coagulase -negative staphylococci: 46% versus 88%; p = 0.013, respectively). On multivariable analysis, late acute PJI was the only independent factor associated with an unsuccessful DAIR when caused by S. aureus (OR 4.52 [95% CI 1.79 to 11.41]; p < 0.001). Conclusions Although DAIR seems to be a successful therapeutic strategy in the management of early acute PJI, its use in late acute PJI should be reconsidered when caused by Staphylococcus spp. Our results advocate the importance of isolating the causative microorganism before surgery .
PB Lippincott Williams & Wilkins
YR 2020
FD 2020-06
LK http://hdl.handle.net/10668/15174
UL http://hdl.handle.net/10668/15174
LA en
NO Wouthuyzen-Bakker M, Sebillotte M, Huotari K, Escudero Sánchez R, Benavent E, Parvizi J, et al. Lower Success Rate of Débridement and Implant Retention in Late Acute versus Early Acute Periprosthetic Joint Infection Caused by Staphylococcus spp. Results from a Matched Cohort Study. Clin Orthop Relat Res. 2020 Jun;478(6):1348-1355.
DS RISalud
RD Jul 6, 2025