One hundred and twelve infected arthroplasties treated with 'DAIR' (debridement, antibiotics and implant retention): antibiotic duration and outcome.
One hundred and twelve infected arthroplasties treated with 'DAIR' (debridement, antibiotics and implant retention): antibiotic duration and outcome.
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DOI：
10.1093/jac/dkp107
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发表时间：
2009-06
期刊：
影响因子：
--
通讯作者：
Berendt A
中科院分区：
文献类型：
--
作者：
Byren I;Bejon P;Atkins BL;Angus B;Masters S;McLardy-Smith P;Gundle R;Berendt A
我们通过清创、抗生素和植入物保留 (DAIR) 管理的假体关节感染 (PJI) 的抗生素持续时间来描述治疗失败率。我们回顾性收集了 5 年来使用 DAIR 治疗的所有 PJI 病例的数据。使用手术清创、微生物取样、早期静脉注射抗生素和长期口服后续抗生素。已发现 112 例 PJI 病例。在平均 2.3 年的随访期间，有 20 例感染 (18%) 复发。抗生素使用的平均持续时间为 1.5 年。对于先前修复的关节和金黄色葡萄球菌感染，关节镜清创后失败更为常见。停用抗生素后有 12 例失败，服用抗生素期间有 8 例失败[风险比 (HR) = 4.3，95% 置信区间 (CI) 1.4–12.8，P = 0.01]。然而，在随访的前 3 个月中，有 8 例在停止抗生素后失败，2 例在使用抗生素期间失败（HR = 7.0，95% CI 1.5-33，P = 0.015）。停止前抗生素治疗的持续时间不能预测结果。 PJI 可能由 DAIR 管理。停止口服抗生素后，这种策略失败的风险会增加，但延长抗生素治疗可能只是推迟而不是预防失败。
We describe treatment failure rates by antibiotic duration for prosthetic joint infection (PJI) managed with debridement, antibiotics and implant retention (DAIR). We retrospectively collected data from all the cases of PJI that were managed with DAIR over a 5 year period. Surgical debridement, microbiological sampling, early intravenous antibiotics and prolonged oral follow-on antibiotics were used. One hundred and twelve cases of PJI were identified. Twenty infections (18%) recurred during a mean follow-up of 2.3 years. The mean duration of antibiotic use was 1.5 years. Failure was more common after arthroscopic debridement, for previously revised joints and for Staphylococcus aureus infection. There were 12 failures after stopping antibiotics and 8 while on antibiotics [hazard ratio (HR) = 4.3, 95% confidence interval (CI) 1.4–12.8, P = 0.01]. However, during the first 3 months of follow-up, there were eight failures after stopping antibiotics and two while on antibiotics (HR = 7.0, 95% CI 1.5–33, P = 0.015). The duration of antibiotic therapy prior to stopping did not predict outcome. PJI may be managed by DAIR. The risk of failure with this strategy rises after stopping oral antibiotics, but lengthening antibiotic therapy may simply postpone, rather than prevent, failure.
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影响因子：
4.9
作者：
DRANCOURT, M;STEIN, A;RAOULT, D
通讯作者：
RAOULT, D
影响因子：
5.2
作者：
Matthews, Philippa C.;Conlon, Christopher P.;Byren, Ivor
通讯作者：
Byren, Ivor
影响因子：
11.8
作者：
Fisman, DN;Reilly, DT;Goldie, SJ
通讯作者：
Goldie, SJ
影响因子：
14.2
作者：
Berdal, JE;Skråmm, I;Bjornholt, JV
通讯作者：
Bjornholt, JV
影响因子：
14.2
作者：
Laffer, RR;Graber, P;Zimmerli, W
通讯作者：
Zimmerli, W