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Should we expand the indications for the DAIR (debridement, antibiotic therapy, and implant retention) procedure for Staphylococcus aureus prosthetic joint infections? A multicenter retrospective study

  • O. Lesens
  • T. Ferry
  • E. Forestier
  • E. Botelho-Nevers
  • P. Pavese
  • E. Piet
  • B. Pereira
  • E. Montbarbon
  • B. Boyer
  • S. Lustig
  • S. Descamps
  • on behalf of the Auvergne-Rhône-Alpes Bone and Joint Infections Study Group
Original Article
  • 239 Downloads

Abstract

To evaluate factors associated with failure in patients treated with DAIR (debridement, antibiotic therapy, and implant retention) for Staphylococcus aureus prosthetic joint infections (PJIs). We retrospectively analyzed consecutive patients with stable PJI due to S. aureus treated with DAIR at six hospitals between 2010 and 2014. Cox proportional hazards regression was used to study factors associated with treatment failure at 2 years. Of 154 eligible patients, 137 were included (mean age 73 ± 13 years; male 56%). The estimated success rate according to the Kaplan–Meier method was 76.2 [95% CI 68–83] at 2 years of follow-up. In multivariate analysis, longer duration of treatment (hazard ratio (HR) 0.78 [0.69–0.88]; p < 0.001) and combination therapy including rifampin (HR 0.08 [0.018–0.36]; p = 0.001) were independently associated with success, whereas active smoking was independently associated with failure (HR 3.6 [1.09–11.84]; p = 0.036). When the analysis was restricted to patients with early infection onset (< 3 months), early acute infection was also predictive of a better prognosis (HR 0.25 [0.09–0.7]; p = 0.009). Failure was not associated with time from prosthesis insertion to debridement, nor with duration of symptoms > 3 weeks and type of prosthesis (hip or knee). These results remained unchanged when the 14 patients under immunosuppressive therapy were removed from analysis. These data suggest that DAIR can be performed even if infection and symptoms are delayed but reserved to patients who are able to follow rifampin-based combination therapy for a prolonged duration that should not be different for hip and knee PJI.

Keywords

Staphylococcus aureus Prosthetic joint infection Lavage DAIR procedure (debridement, antibiotic therapy, and implant retention) Rifampin Biofilm 

Notes

Acknowledgments

Auvergne-Rhône-Alpes Bone and Joint Infections Study Group: Aurore Chabaud, Evelina Petrosyan, Paule Letertre-Gilbert, Natacha Mrozek, Magali Vidal (Clermont-Ferrand), Sandrine Boisset (Grenoble), Celine Cazorla, Frédéric Lucht, Marie-France Lutz, Frédéric Farizon, Davier Marina (Saint-Etienne), Florent Valour, Florence Ader (Lyon).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The study was approved by the regional ethic committee of Auvergne-Rhone-Alpes.

Informed consent

Not required.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • O. Lesens
    • 1
    • 2
  • T. Ferry
    • 3
  • E. Forestier
    • 4
  • E. Botelho-Nevers
    • 5
  • P. Pavese
    • 6
  • E. Piet
    • 7
  • B. Pereira
    • 8
  • E. Montbarbon
    • 9
  • B. Boyer
    • 10
  • S. Lustig
    • 3
  • S. Descamps
    • 11
    • 12
  • on behalf of the Auvergne-Rhône-Alpes Bone and Joint Infections Study Group
  1. 1.Service des Maladies Infectieuses et TropicalesHôpital Gabriel Montpied, CRIOAc, CHUClermont-FerrandFrance
  2. 2.Laboratoire Microorganismes: Génome Environnement (LMGE) UMR 6023Université Clermont AuvergneClermont-FerrandFrance
  3. 3.Hospices Civils de Lyon, CRIOAc LyonUniversité Claude Bernard Lyon 1VilleurbanneFrance
  4. 4.Service de Maladies InfectieusesCH Métropole SavoieChambéryFrance
  5. 5.Service d’Infectiologie, CIC1408-Inserm, CRIOAc Saint-EtienneHôpital Nord-CHU Saint EtienneSaint-EtienneFrance
  6. 6.Service de Maladies InfectieusesCHU Grenoble AlpesGrenobleFrance
  7. 7.Service d’InfectiologieCH Annecy GenevoisAnnecyFrance
  8. 8.CHU Clermont-Ferrand, DRCI–BiostatistiqueClermont-FerrandFrance
  9. 9.Service d’Orthopédie-TraumatologieCH Metropole SavoieChambéryFrance
  10. 10.Service Orthopédie, CRIOAc Saint-EtienneHôpital Nord–CHU Saint-EtienneSaint-EtienneFrance
  11. 11.Université Clermont- Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCFClermont-FerrandFrance
  12. 12.Institut de Chimie de Clermont-Ferrand (ICCF), UMR 6296AubiereFrance

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