Advertisement

International Orthopaedics

, Volume 39, Issue 3, pp 397–401 | Cite as

Increased risk of joint failure in hip prostheses infected with Staphylococcus aureus treated with debridement, antibiotics and implant retention compared to Streptococcus

  • Michael Betz
  • Sophie Abrassart
  • Pierre Vaudaux
  • Ergys Gjika
  • Maximilian Schindler
  • Julien Billières
  • Besa Zenelaj
  • Domizio Suvà
  • Robin Peter
  • Ilker Uçkay
Original Paper

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.

Keywords

Total hip arthroplasty Infection Retention Streptococci Staphylococcus aureus 

Notes

Acknowledgments

We thank Prof. Benjamin A. Lipsky, the Orthopedic Service and the Laboratory of Microbiology for their support.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Giulieri SG, Graber P, Ochsner PE, Zimmerli W (2004) Management of infection associated with total hip arthroplasty according to a treatment algorithm. Infection 32:222–228CrossRefPubMedGoogle Scholar
  2. 2.
    Tattevin P, Crémieux AC, Pottier P, Huten D, Carbon C (1999) Prosthetic joint infection: when can prosthesis salvage be considered? Clin Infect Dis 29:292–295CrossRefPubMedGoogle Scholar
  3. 3.
    Sukeik M, Patel S, Haddad FS (2012) Aggressive early debridement for treatment of acutely infected cemented total hip arthroplasty. Clin Orthop Relat Res 470:3164–3170CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    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 42:471–478CrossRefPubMedGoogle Scholar
  5. 5.
    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 119:7–10CrossRefGoogle Scholar
  6. 6.
    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 84:380–386CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    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 63:1264–1271CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    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 31:3367–3374CrossRefPubMedGoogle Scholar
  9. 9.
    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 37:2253–2258CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Uçkay I, Jugun K, Gamulin A, Wagener J, Hoffmeyer P, Lew D (2012) Chronic osteomyelitis. Curr Infect Dis Rep 14:566–575CrossRefPubMedGoogle Scholar
  11. 11.
    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 37:1471–1475CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    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 304:565–576CrossRefPubMedGoogle Scholar
  13. 13.
    Uçkay I, Pittet D, Vaudaux P, Sax H, Lew DP, Waldvogel F (2009) Foreign body infections due to Staphylococcus epidermidis. Ann Med 41:109–119CrossRefPubMedGoogle Scholar
  14. 14.
    Vaudaux P, Kelley WL, Lew DP (2006) Staphylococcus aureus small colony variants: difficult to diagnose and difficult to treat. Clin Infect Dis 43:968–970CrossRefPubMedGoogle Scholar
  15. 15.
    Chargui M, Uçkay I, Suvà D, Christofilopoulos P, Lomessy A, Pittet D (2014) Deep soft tissue infections. Rev Med Suisse 10:920–924PubMedGoogle Scholar
  16. 16.
    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 79:64–69CrossRefPubMedGoogle Scholar
  17. 17.
    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 26:114–118CrossRefPubMedGoogle Scholar
  18. 18.
    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 80:1306–1313PubMedGoogle Scholar
  19. 19.
    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 25:1022–1027CrossRefPubMedGoogle Scholar
  20. 20.
    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 17:1632–1637CrossRefPubMedGoogle Scholar
  21. 21.
    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 36:1065–1071CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    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 13:586–591CrossRefPubMedGoogle Scholar
  23. 23.
    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 12:930–933CrossRefPubMedGoogle Scholar
  24. 24.
    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 37:1214–1218CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Segreti J, Nelson JA, Trenholme GM (1998) Prolonged suppressive antibiotic therapy for infected orthopedic prostheses. Clin Infect Dis 27:711–713CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2014

Authors and Affiliations

  • Michael Betz
    • 1
  • Sophie Abrassart
    • 1
  • Pierre Vaudaux
    • 2
  • Ergys Gjika
    • 1
  • Maximilian Schindler
    • 1
  • Julien Billières
    • 1
  • Besa Zenelaj
    • 1
  • Domizio Suvà
    • 1
  • Robin Peter
    • 1
  • Ilker Uçkay
    • 1
    • 2
  1. 1.Orthopedic Surgery ServiceGeneva University Hospitals & Medical School, University of GenevaGenevaSwitzerland
  2. 2.Service of Infectious DiseasesGeneva University Hospitals & Medical School, University of GenevaGenevaSwitzerland

Personalised recommendations