Implant Removal in the Management of Prosthetic Joint Infection by Staphylococcus aureus: Outcome and Predictors of Failure in a Large Retrospective Multicenter Study

Objectives: To compare the characteristics and outcomes of cases with acute prosthetic joint infection (PJI; early post-surgical or hematogenous) by Staphylococcus aureus managed with implant removal (IRm) or debridement and retention (DAIR). To analyze the outcomes of all cases managed with IRm (initially or after DAIR failure). Methods: Retrospective, multicenter, cohort study of PJI by S. aureus (2003–2010). Overall failure included mortality within 60 days since surgery and local failure due to staphylococcal persistence/relapse. Results: 499 cases, 338 initially managed with DAIR, 161 with IRm. Mortality was higher in acute PJI managed initially with IRm compared to DAIR, but not associated with the surgical procedure, after propensity score matching. Underlying conditions, hemiarthroplasty, and methicillin-resistant S. aureus were risk factors for mortality. Finally, 249 cases underwent IRm (88 after DAIR failure); overall failure was 15.6%. Local failure (9.3%) was slightly higher in cases with several comorbidities, but independent of previous DAIR, type of IRm, and rifampin treatment. Conclusions: In a large multicenter study of S. aureus PJI managed with IRm, failure was low, but mortality significant, especially in cases with acute PJI and underlying conditions, but not associated with the IRm itself. Rifampin efficacy was limited in this setting.

[1]  R. Poolman,et al.  Hip and Knee Section, Treatment, Algorithm: Proceedings of International Consensus on Orthopedic Infections. , 2019, The Journal of arthroplasty.

[2]  M. Ferrari,et al.  Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention. , 2018, Journal of Infection.

[3]  D. Dennis,et al.  Hip and Knee Section, Diagnosis, Definitions: Proceedings of International Consensus on Orthopedic Infections. , 2019, The Journal of arthroplasty.

[4]  J. Ariza,et al.  Analysis of mortality in a cohort of 650 cases of bacteremic osteoarticular infections. , 2018, Seminars in arthritis and rheumatism.

[5]  A. Rajgopal,et al.  Does Prior Failed Debridement Compromise the Outcome of Subsequent Two-Stage Revision Done for Periprosthetic Joint Infection Following Total Knee Arthroplasty? , 2018, The Journal of arthroplasty.

[6]  S. Kurtz,et al.  Are We Winning or Losing the Battle With Periprosthetic Joint Infection: Trends in Periprosthetic Joint Infection and Mortality Risk for the Medicare Population. , 2018, The Journal of arthroplasty.

[7]  T. Peel,et al.  Prosthetic Joint Infections , 2018, Springer International Publishing.

[8]  D. Berry,et al.  Irrigation and Debridement with Component Retention for Acute Infection After Hip Arthroplasty: Improved Results with Contemporary Management , 2017, The Journal of bone and joint surgery. American volume.

[9]  Á. Soriano,et al.  Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study. , 2016, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[10]  T. Randau,et al.  Outcome Predictors in Prosthetic Joint Infections--Validation of a risk stratification score for Prosthetic Joint Infections in 120 cases. , 2016, Acta orthopaedica Belgica.

[11]  Á. Soriano,et al.  KLIC-score for predicting early failure in prosthetic joint infections treated with debridement, implant retention and antibiotics. , 2015, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[12]  S. Tibrewal,et al.  Single-stage revision for the infected total knee replacement: results from a single centre. , 2014, The bone & joint journal.

[13]  J. Ariza,et al.  Infected hip hemiarthroplasties and total hip arthroplasties: Differential findings and prognosis. , 2013, The Journal of infection.

[14]  Á. Soriano,et al.  A large multicenter study of methicillin-susceptible and methicillin-resistant Staphylococcus aureus prosthetic joint infections managed with implant retention. , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[15]  A. Hanssen,et al.  Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[16]  Henri Migaud,et al.  Outcome and Predictors of Treatment Failure in Total Hip/Knee Prosthetic Joint Infections Due to Staphylococcus aureus , 2011, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[17]  S. Odum,et al.  The Chitranjan Ranawat Award: Fate of Two-stage Reimplantation After Failed Irrigation and Débridement for Periprosthetic Knee Infection , 2011, Clinical orthopaedics and related research.

[18]  Alimuddin Zumla Mandell, Douglas, and Bennett's principles and practice of infectious diseases , 2010, The Lancet Infectious Diseases.

[19]  Robin Patel,et al.  Clinical practice. Infection associated with prosthetic joints. , 2009, The New England journal of medicine.

[20]  P. Bejon,et al.  One hundred and twelve infected arthroplasties treated with ‘DAIR’ (debridement, antibiotics and implant retention): antibiotic duration and outcome , 2009, The Journal of antimicrobial chemotherapy.

[21]  P. Choong,et al.  Treatment of staphylococcal prosthetic joint infections with debridement, prosthesis retention and oral rifampicin and fusidic acid. , 2007, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[22]  W. J. Hart,et al.  Two-stage revision of infected total knee replacements using articulating cement spacers and short-term antibiotic therapy. , 2006, The Journal of bone and joint surgery. British volume.

[23]  J. Mandrekar,et al.  Outcome of prosthetic joint infections treated with debridement and retention of components. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[24]  P. Holtom,et al.  Periprosthetic Total Hip Infection: Outcomes Using a Staging System , 2002, Clinical orthopaedics and related research.

[25]  P. McLardy-Smith,et al.  Prosthetic joint infection , 1999, Current infectious disease reports.

[26]  A. Hanssen,et al.  Staphylococcus aureus prosthetic joint infection treated with prosthesis removal and delayed reimplantation arthroplasty. , 1999, Mayo Clinic proceedings.

[27]  P E Ochsner,et al.  Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group. , 1998, JAMA.

[28]  A. Hanssen,et al.  Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[29]  R. Gustilo,et al.  Infection after Total Hip Arthroplasty. A Study of the Treatment of One Hundred and Six Infections* , 1996, The Journal of bone and joint surgery. American volume.