Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Tande AJ, Patel R (2014) Prosthetic joint infection. Clin Microbiol Rev 27(2):302–345

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl J Med 351(16):1645–1654

    Article  CAS  PubMed  Google Scholar 

  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–e25

    Article  PubMed  Google Scholar 

  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):185–211

    Article  Google Scholar 

  5. https://www.has-sante.fr/portail/upload/docs/application/pdf/2014-04/rbp_reco2clics_protheses_infectees.pdf; last accessed 23 Nov 2017

  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):583–587

    Article  CAS  PubMed  Google Scholar 

  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):182–194

    Article  PubMed  Google Scholar 

  8. Barrett L, Atkins B (2014) The clinical presentation of prosthetic joint infection. J Antimicrob Chemother 69(Suppl 1):i25–i27

    Article  CAS  PubMed  Google Scholar 

  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):1577–1585

    Article  CAS  PubMed  Google Scholar 

  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):39–47

    Article  CAS  PubMed  Google Scholar 

  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):334–340

    Article  PubMed  PubMed Central  Google Scholar 

  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):1537–1541

    Article  CAS  PubMed  Google Scholar 

  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):1785–1791

    Article  PubMed  Google Scholar 

  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 3:2

    Article  PubMed  PubMed Central  Google Scholar 

  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):310–316

    Article  CAS  PubMed  Google Scholar 

Download references

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).

Author information

Authors and Affiliations

  1. Service des Maladies Infectieuses et Tropicales, Hôpital Gabriel Montpied, CRIOAc, CHU, Clermont-Ferrand, France

    O. Lesens

  2. Laboratoire Microorganismes: Génome Environnement (LMGE) UMR 6023, Université Clermont Auvergne, Clermont-Ferrand, France

    O. Lesens

  3. Hospices Civils de Lyon, CRIOAc Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France

    T. Ferry & S. Lustig

  4. Service de Maladies Infectieuses, CH Métropole Savoie, Chambéry, France

    E. Forestier

  5. Service d’Infectiologie, CIC1408-Inserm, CRIOAc Saint-Etienne, Hôpital Nord-CHU Saint Etienne, 42055, Saint-Etienne, France

    E. Botelho-Nevers

  6. Service de Maladies Infectieuses, CHU Grenoble Alpes, Grenoble, France

    P. Pavese

  7. Service d’Infectiologie, CH Annecy Genevois, 74000, Annecy, France

    E. Piet

  8. CHU Clermont-Ferrand, DRCI–Biostatistique, Clermont-Ferrand, France

    B. Pereira

  9. Service d’Orthopédie-Traumatologie, CH Metropole Savoie, Chambéry, France

    E. Montbarbon

  10. Service Orthopédie, CRIOAc Saint-Etienne, Hôpital Nord–CHU Saint-Etienne, Saint-Etienne, France

    B. Boyer

  11. Université Clermont- Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000, Clermont-Ferrand, France

    S. Descamps

  12. Institut de Chimie de Clermont-Ferrand (ICCF), UMR 6296, 24, avenue Blaise-Pascal, 63178, Aubiere, France

    S. Descamps

Authors
  1. O. Lesens
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Ferry
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Forestier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Botelho-Nevers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Pavese
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Piet
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. B. Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. E. Montbarbon
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. B. Boyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S. Lustig
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. S. Descamps
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the Auvergne-Rhône-Alpes Bone and Joint Infections Study Group

  • Aurore Chabaud
  • , Evelina Petrosyan
  • , Paule Letertre-Gilbert
  • , Natacha Mrozek
  • , Magali Vidal
  • , Sandrine Boisset
  • , Celine Cazorla
  • , Frédéric Lucht
  • , Marie-France Lutz
  • , Frédéric Farizon
  • , Davier Marina
  • , Florent Valour
  •  & Florence Ader

Corresponding author

Correspondence to O. Lesens.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lesens, O., Ferry, T., Forestier, E. et al. 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. Eur J Clin Microbiol Infect Dis 37, 1949–1956 (2018). https://doi.org/10.1007/s10096-018-3330-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-018-3330-7

Keywords

Search

Navigation