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. LesensEmail author
  • 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


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.


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



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.


  1. 1.
    Tande AJ, Patel R (2014) Prosthetic joint infection. Clin Microbiol Rev 27(2):302–345CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl J Med 351(16):1645–1654CrossRefPubMedGoogle Scholar
  3. 3.
    Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson WR, Infectious Diseases Society of America (2013) Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 56(1):e1–e25CrossRefPubMedGoogle Scholar
  4. 4.
    Société de Pathologie Infectieuse de Langue Française (SPILF); Collège des Universitaires de Maladies Infectieuses et Tropicales (CMIT); Groupe de Pathologie Infectieuse Pédiatrique (GPIP); Société Française d’Anesthésie et de Réanimation (SFAR); Société Française de Chirurgie Orthopédique et Traumatologique (SOFCOT); Société Française d’Hygiène Hospitalière (SFHH); Société Française de Médecine Nucléaire (SFMN); Société Française de Médecine Physique et de Réadaptation (SOFMER); Société Française de Microbiologie (SFM); Société Française de Radiologie (SFR-Rad); Société Française de Rhumatologie(SFR-Rhu). Recommendations for bone and joint prosthetic device infections in clinical practice (prosthesis, implants, osteosynthesis) (2010) Société de Pathologie Infectieuse de Langue Française. Med Mal Infect 40(4):185–211CrossRefGoogle Scholar
  5. 5.
  6. 6.
    Ollivier M, Senneville E, Drancourt M, Argenson JN, Migaud H (2014) Potential changes to French recommendations about peri-prosthetic infections based on the international consensus meeting (ICMPJI). Orthop Traumatol Surg Res 100(6):583–587CrossRefPubMedGoogle Scholar
  7. 7.
    Lora-Tamayo J, Murillo O, Iribarren JA, Soriano A, Sánchez-Somolinos M, Baraia-Etxaburu JM, Rico A, Palomino J, Rodríguez-Pardo D, Horcajada JP, Benito N, Bahamonde A, Granados A, del Toro MD, Cobo J, Riera M, Ramos A, Jover-Sáenz A, Ariza J, REIPI Group for the Study of Prosthetic Infection (2013) A large multicenter study of methicillin-susceptible and methicillin-resistant Staphylococcus aureus prosthetic joint infections managed with implant retention. Clin Infect Dis 56(2):182–194CrossRefPubMedGoogle Scholar
  8. 8.
    Barrett L, Atkins B (2014) The clinical presentation of prosthetic joint infection. J Antimicrob Chemother 69(Suppl 1):i25–i27CrossRefPubMedGoogle Scholar
  9. 9.
    Prendki V, Ferry T, Sergent P, Oziol E, Forestier E, Fraisse T, Tounes S, Ansart S, Gaillat J, Bayle S, Ruyer O, Borlot F, Le Falher G, Simorre B, Dauchy FA, Greffe S, Bauer T, Bell EN, Martha B, Martinot M, Froidure M, Buisson M, Waldner A, Lemaire X, Bosseray A, Maillet M, Charvet V, Barrelet A, Wyplosz B, Noaillon M, Denes E, Beretti E, Berlioz-Thibal M, Meyssonnier V, Fourniols E, Tliba L, Eden A, Jean M, Arvieux C, Guignery-Kadri K, Ronde-Oustau C, Hansmann Y, Belkacem A, Bouchand F, Gavazzi G, Herrmann F, Stirnemann J, Dinh A (2017) Prolonged suppressive antibiotic therapy for prosthetic joint infection in the elderly: a national multicentre cohort study. Eur J Clin Microbiol Infect Dis 36(9):1577–1585CrossRefPubMedGoogle Scholar
  10. 10.
    Pradier M, Robineau O, Boucher A, Titecat M, Blondiaux N, Valette M, Loïez C, Beltrand E, Nguyen S, Dézeque H, Migaud H, Senneville E (2018) Suppressive antibiotic therapy with oral tetracyclines for prosthetic joint infections: a retrospective study of 78 patients. Infection 46(1):39–47CrossRefPubMedGoogle Scholar
  11. 11.
    Senneville E, Joulie D, Legout L, Valette M, Dezèque H, Beltrand E, Roselé B, d'Escrivan T, Loïez C, Caillaux M, Yazdanpanah Y, Maynou C, Migaud H (2011) Outcome and predictors of treatment failure in total hip/knee prosthetic joint infections due to Staphylococcus aureus. Clin Infect Dis 53(4):334–340CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Zimmerli W, Widmer AF, Blatter M, Frei R, Ochsner PE (1998) Role of rifampin for treatment of orthopedic implant–related staphylococcal infections: a randomized controlled trial. JAMA 279(19):1537–1541CrossRefPubMedGoogle Scholar
  13. 13.
    Puhto AP, Puhto T, Niinimäki T, Ohtonen P, Leppilahti J, Syrjälä H (2015) Predictors of treatment outcome in prosthetic joint infections treated with prosthesis retention. Int Orthop 39(9):1785–1791CrossRefPubMedGoogle Scholar
  14. 14.
    Qasim SN, Swann A, Ashford R (2017) The DAIR (debridement, antibiotics and implant retention) procedure for infected total knee replacement – a literature review. SICOT J 3:2CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Lora-Tamayo J, Euba G, Cobo J, Horcajada JP, Soriano A, Sandoval E, Pigrau C, Benito N, Falgueras L, Palomino J, Del Toro MD, Jover-Sáenz A, Iribarren JA, Sánchez-Somolinos M, Ramos A, Fernández-Sampedro M, Riera M, Baraia-Etxaburu JM, Ariza J, Prosthetic Joint Infection Group of the Spanish Network for Research in Infectious Diseases—REIPI (2016) Short- versus long-duration levofloxacin plus rifampicin for acute staphylococcal prosthetic joint infection managed with implant retention: a randomised clinical trial. Int J Antimicrob Agents 48(3):310–316CrossRefPubMedGoogle Scholar

Copyright information

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

Authors and Affiliations

  • O. Lesens
    • 1
    • 2
    Email author
  • 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

Personalised recommendations