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Polymicrobial Infection Is Associated with Failure of DAIR in Acute Hip Periprosthetic Joint Infection
José María Lamo-Espinosa1,2, Álvaro Suárez-López Del Amo3, Francisco Carmona-Torre4,5
1Orthopedic and Traumatology Surgery Department, Hospital Biomédico ASCIRES, Valencia, Spain.
Background:
Debridement, antibiotics, and implant retention (DAIR) is a commonly used tactic for the management of acute periprosthetic joint infection (PJI) following total hip arthroplasty. However, patient selection remains challenging, and predictors of treatment failure are not clearly defined.
Patients And Methods:
A retrospective cohort study was conducted in a single center including 48 patients treated with DAIR for acute hip PJI between 2000 and 2019. Clinical characteristics, comorbidities, microbiological findings, and perioperative variables were analyzed. Treatment failure was defined as the need for implant removal or exchange, resection arthroplasty, or chronic suppressive antibiotic therapy. Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to explore factors associated with DAIR failure.
Results:
The mean age was 69.3 years. At a mean follow-up of 23.7 months, infection control was achieved in 83.3% of cases. Polymicrobial infection was significantly associated with treatment failure compared with monomicrobial infection (57.1% vs. 87.5%, p = 0.049). An exploratory predictive model demonstrated acceptable to good discriminatory performance in this exploratory cohort for DAIR outcome (area under the curve = 0.87).
Conclusions:
DAIR is an effective treatment option for selected patients with acute hip PJI. Polymicrobial infection was associated with treatment failure and should prompt careful consideration of alternative surgical strategies. Exploratory risk stratification models may assist in preoperative decision-making; however, validation in larger cohorts is required.
Insights
Debridement, antibiotics, and implant retention (DAIR) effectively treats acute hip periprosthetic joint infection (PJI) in selected patients. Polymicrobial infections increase failure risk, necessitating careful patient selection and risk assessment for DAIR success.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Arthroplasty Management
Background:
- Debridement, antibiotics, and implant retention (DAIR) is a standard approach for acute periprosthetic joint infection (PJI) after hip arthroplasty.
- Optimal patient selection and understanding predictors of DAIR failure remain critical challenges.
Purpose of the Study:
- To evaluate the effectiveness of DAIR for acute hip PJI.
- To identify predictors of treatment failure in patients undergoing DAIR for hip PJI.
Main Methods:
- Retrospective cohort study of 48 patients with acute hip PJI treated with DAIR.
- Analysis of clinical characteristics, comorbidities, microbiology, and perioperative variables.
- Multivariable logistic regression and ROC curve analysis to identify failure predictors.
Main Results:
- DAIR achieved infection control in 83.3% of cases at a mean follow-up of 23.7 months.
- Polymicrobial infection was significantly associated with higher treatment failure rates (p=0.049).
- An exploratory predictive model showed good discriminatory performance (AUC=0.87) for DAIR outcome.
Conclusions:
- DAIR is effective for carefully selected acute hip PJI patients.
- Polymicrobial infections warrant consideration of alternative surgical strategies.
- Exploratory risk models may aid preoperative decisions, requiring validation in larger studies.
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