Abstract
Purpose
The debridement, antibiotic and implant retention (DAIR) procedure is an option for patients with prosthetic hip joint infections for whom arthroplasty removal is problematic. Unfortunately, some of the guidelines proposed for deciding on DAIR management of arthroplasty infections fail to take into consideration the role of the infecting pathogen. While Staphylococcus aureus and streptococci are major contributors to infected hip arthroplasties, their respective contributions to treatment success or failure rates with the DAIR procedure have not been thoroughly analysed from a microbiological perspective.
Methods
This retrospective study included all patients who were hospitalised in Geneva University Hospitals between 1996 and 2012 and were initially treated with DAIR for prosthetic hip joint monomicrobial infection due to S. aureus or Streptococcus spp. The outcome of DAIR treatment was evaluated after a minimal follow-up of two years. A literature search was also performed to retrieve data from additional DAIR-treated cases in other institutions.
Results
In our institution, 38 DAIR-treated patients with hip arthroplasty monomicrobial infections underwent at least one surgical debridement (median two, range one to five), exchange of mobile parts and concomitant targeted antibiotic therapy for several weeks or months. A literature search identified outcome data in other institutions from 52 additional DAIR-treated cases according to our study criteria. After merging our own data with those retrieved from other reports, we found a failure rate of 21 % instead of 24 % for S. aureus-infected, DAIR-treated patients, but no failure in 14 streptococcal-infected patients. In the pooled data, the failure rate linked with S. aureus infections was significantly higher than that with Streptococcus ssp. (19/90 vs 0/14 episodes; Fisher’s exact test, P = 0.07).
Conclusions
DAIR-treated patients with prosthetic hip joint infections due to S. aureus tended to have worse outcomes than those infected with Streptococcus spp. The specific influence of the infecting pathogen should be considered in future guidelines and recommendations.
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References
Giulieri SG, Graber P, Ochsner PE, Zimmerli W (2004) Management of infection associated with total hip arthroplasty according to a treatment algorithm. Infection 32:222–228
Tattevin P, Crémieux AC, Pottier P, Huten D, Carbon C (1999) Prosthetic joint infection: when can prosthesis salvage be considered? Clin Infect Dis 29:292–295
Sukeik M, Patel S, Haddad FS (2012) Aggressive early debridement for treatment of acutely infected cemented total hip arthroplasty. Clin Orthop Relat Res 470:3164–3170
Marculescu CE, Berbari EF, Hanssen AD, Steckelberg JM, Harmsen SW, Mandrekar JN et al (2006) Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis 42:471–478
Barberan J, Aguilar L, Carroquino G, Giménez MJ, Sánchez B, Martínez D et al (2006) Conservative treatment of staphylococcal prosthetic joint infections in elderly patients. Am J Med 119:7–10
Kuiper JW, Vos SJ, Saouti R, Vergroesen DA, Graat HCA, Debets-Ossenkopp YJ et al (2013) Prosthetic joint-associated infections treated with DAIR (debridement, antibiotics, irrigation, and retention): analysis of risk factors and local antibiotic carriers in 91 patients. Acta Orthop 84:380–386
Byren I, Bejon P, Atkins BL, Angus B, Masters S, McLardy-Smith P et al (2009) One hundred and twelve infected arthroplasties treated with ‘DAIR’ (debridement, antibiotics and implant retention): antibiotic duration and outcome. J Antimicrob Chemother 63:1264–1271
Vaudaux P, Ferry T, Uçkay I, François P, Schrenzel J, Harbarth S et al (2012) Prevalence of isolates with reduced glycopeptide susceptibility in orthopedic device-related infections due to methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 31:3367–3374
Al-Mayahi M, Betz M, Müller DA, Stern R, Tahintzi P, Bernard L et al (2013) Remission rate of implant-related infections following revision surgery after fractures. Int Orthop 37:2253–2258
Uçkay I, Jugun K, Gamulin A, Wagener J, Hoffmeyer P, Lew D (2012) Chronic osteomyelitis. Curr Infect Dis Rep 14:566–575
Zürcher-Pfund L, Uçkay I, Legout L, Gamulin A, Vaudaux P, Peter R (2013) Pathogen-driven decision for implant retention in the management of infected total knee prostheses. Int Orthop 37:1471–1475
Post V, Wahl P, Uçkay I, Ochsner P, Zimmerli W, Corvec S et al (2014) Phenotypic and genotypic characterisation of Staphylococcus aureus causing musculoskeletal infections. Int J Med Microbiol 304:565–576
Uçkay I, Pittet D, Vaudaux P, Sax H, Lew DP, Waldvogel F (2009) Foreign body infections due to Staphylococcus epidermidis. Ann Med 41:109–119
Vaudaux P, Kelley WL, Lew DP (2006) Staphylococcus aureus small colony variants: difficult to diagnose and difficult to treat. Clin Infect Dis 43:968–970
Chargui M, Uçkay I, Suvà D, Christofilopoulos P, Lomessy A, Pittet D (2014) Deep soft tissue infections. Rev Med Suisse 10:920–924
Sendi P, Christensson B, Uçkay I, Trampuz A, Remschmidt C, Boggian K et al (2011) Group B streptococcus in prosthetic hip and knee joint-associated infections. J Hosp Infect 79:64–69
Odum SM, Fehring TK, Lombardi AV, Zmistowski BM, Brown NM, Luna JT et al (2011) Irrigation and debridement for periprosthetic infections: does the organism matter? J Arthroplasty 26:114–118
Crockarell JR, Hanssen AD, Osmon DR, Morrey BF (1998) Treatment of infection with débridement and retention of the components following hip arthroplasty. J Bone Joint Surg Am 80:1306–1313
Azzam KA, Seeley M, Ghanem E, Austin MS, Purtill JJ, Parvizi J (2010) Irrigation and debridement in the management of prosthetic joint infection: traditional indications revisited. J Arthroplasty 25:1022–1027
Cobo J, Miguel LG, Euba G, Rodríguez D, García-Lechuz JM, Riera M et al (2011) Early prosthetic joint infection: outcomes with debridement and implant retention followed by antibiotic therapy. Clin Microbiol Infect 17:1632–1637
Seghrouchni K, van Delden C, Dominguez D, Benkabouche M, Bernard L, Assal M et al (2012) Remission after treatment of osteoarticular infections due to Pseudomonas aeruginosa versus Staphylococcus aureus: a case-controlled study. Int Orthop 36:1065–1071
Aboltins CA, Page MA, Buising KL, Jenney AWJ, Daffy JR, Choong FM et al (2007) Treatment of staphylococcal prosthetic joint infections with debridement, prosthesis retention and oral rifampicin and fusidic acid. Clin Microbiol Infect 13:586–591
Soriano A, García S, Bori G, Almela M, Gallart X, Macule F et al (2006) Treatment of acute post-surgical infection of joint arthroplasty. Clin Microbiol Infect 12:930–933
Drancourt M, Stein A, Argenson JN, Zannier A, Curvale G, Raoult D (1993) Oral rifampin plus ofloxacin for treatment of Staphylococcus-infected orthopedic implants. Antimicrob Agents Chemother 37:1214–1218
Segreti J, Nelson JA, Trenholme GM (1998) Prolonged suppressive antibiotic therapy for infected orthopedic prostheses. Clin Infect Dis 27:711–713
Acknowledgments
We thank Prof. Benjamin A. Lipsky, the Orthopedic Service and the Laboratory of Microbiology for their support.
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The authors declare that they have no conflict of interest.
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Betz, M., Abrassart, S., Vaudaux, P. et al. Increased risk of joint failure in hip prostheses infected with Staphylococcus aureus treated with debridement, antibiotics and implant retention compared to Streptococcus . International Orthopaedics (SICOT) 39, 397–401 (2015). https://doi.org/10.1007/s00264-014-2510-z
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DOI: https://doi.org/10.1007/s00264-014-2510-z