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Predictors of treatment outcome in prosthetic joint infections treated with prosthesis retention

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Abstract

Purpose

The reported success rates of debridement, antibiotics, and implant retention (DAIR) for prosthetic joint infections (PJIs) vary widely. Several risk factors have been described for treatment failure, but they vary between studies. The purpose of this study was to evaluate the predictors of DAIR failure in PJI treatment and to assess the efficacy of rifampin combined with ciprofloxacin versus rifampin combined with other antibiotics in staphylococcal PJIs.

Methods

Patients with PJI that underwent DAIR for the first time between February 2001 and August 2009 were identified retrospectively in the hospital’s patient databases. A total of 113 PJI cases with early postoperative or acute haematogenous PJI were followed for up to two years from the start of treatment.

Results

In univariate analysis, variables significantly associated with treatment failure were acute haematogenous infections (p = 0.022), leucocyte count at admission > 10 × 109/l (p < 0.01), pain in the joint (p < 0.01), and ineffective empirical antibiotics (p < 0.01). In a multivariate Cox model, leucocyte count > 10 × 109/l and ineffective empirical antibiotics were significant risk factors for failure. Compared to rifampin-ciprofloxacin, the hazard ratio (HR) for treatment failure was significantly increased in the rifampin-other antibiotics group (HR 6.0, 95 % CI 1.5−28.8, p = 0.014) and the group treated without rifampin (HR 14.4, 95 % CI 3.1−66.9, p < 0.01).

Conclusions

Rifampin-ciprofloxacin combination therapy was significantly more effective than rifampin combined with other antibiotics. Effective empirical antibiotics are essential for successful PJI treatment.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, P.O. Box 21, 90029 OYS, Oulu, Finland

    Ari-Pekka Puhto, Tuukka Niinimäki & Juhana Leppilahti

  2. Division of Operative Care, Department of Infection Control, Oulu University Hospital, Oulu, Finland

    Teija Puhto & Hannu Syrjälä

  3. Division of Operative Care, Research and development, Oulu University Hospital, Oulu, Finland

    Pasi Ohtonen

Authors
  1. Ari-Pekka Puhto
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  2. Teija Puhto
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  3. Tuukka Niinimäki
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Correspondence to Ari-Pekka Puhto.

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Puhto, AP., Puhto, T., Niinimäki, T. et al. Predictors of treatment outcome in prosthetic joint infections treated with prosthesis retention. International Orthopaedics (SICOT) 39, 1785–1791 (2015). https://doi.org/10.1007/s00264-015-2819-2

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  • DOI: https://doi.org/10.1007/s00264-015-2819-2

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