Failure of Irrigation and D,bridement for Early Postoperative Periprosthetic Infection
Failure of Irrigation and D,bridement for Early Postoperative Periprosthetic Infection
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DOI：
10.1007/s11999-012-2373-9
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发表时间：
2013-01-01
影响因子：
4.2
通讯作者：
Gioe, Terence J.
中科院分区：
文献类型：
--
作者：
Fehring, Thomas K.;Odum, Susan M.;Gioe, Terence J.
假体周围感染（PPI）的冲洗和创面（I&D）与感染控制相关，范围从16%到47%。缓解因素包括生物体类型、宿主因素和干预时机。虽然生物类型和宿主因素的影响已经明确，但干预的时机仍然不清楚。我们研究了以下问题：初次手术后90天内进行i&d的失败率是多少？哪些因素与失败有关？我们对原发性手术后90天内PPI患者的I&D进行了多中心回顾性分析。我们纳入86例患者（男44例，女42例），平均年龄61岁。失败被定义为因感染相关问题返回手术室。我们确定了初次手术后90天内I&D的失败率，以及检查感染的几率是否与Charlson合并症指数、年龄、性别、关节、机体类型和时间有关。最小随访时间为24个月（平均46个月，范围24-106个月）。86例患者中有54例（63%）失败。10例中有8例（80%）在术后10天内失败，57例中有32例（56%）在术后4周内失败，29例中有22例（76%）在术后31 ~ 90天内失败。没有协变量与感染的后续翻修手术相关。PPI的I&D常用于术后早期控制感染。虽然在大多数情况下，假设早期干预将导致感染得到控制，但我们的数据与这一假设相矛盾。III级，治疗性研究。有关证据水平的完整描述，请参见作者说明。
Irrigation and d,bridement (I&D) of periprosthetic infection (PPI) is associated with infection control ranging from 16% to 47%. Mitigating factors include organism type, host factors, and timing of intervention. While the influence of organism type and host factors has been clarified, the timing of intervention remains unclear.We addressed the following questions: What is the failure rate of I&Ds performed within 90 days of primary surgery? And what factors are associated with failure?We performed a multicenter retrospective analysis of I&D for PPI within 90 days of primary surgery. We included 86 patients (44 males, 42 females) with an average age of 61 years. Failure was defined as return to the operating room for an infection-related problem. We determined the failure rate of I&D within 90 days of primary surgery and whether the odds of rerevision for infection were associated with Charlson Comorbidity Index, age, sex, joint, organism type, and timing. The minimum followup was 24 months (average, 46 months; range, 24-106 months).54 of 86 patients (63%) failed. Eight of 10 (80%) failed within the first 10 days, 32 of 57 (56%) within 4 weeks, and 22 of 29 (76%) within 31 to 90 days postoperatively. No covariates were associated with subsequent revision surgery for infection.I&D for PPI is frequently used in the early postoperative period to control infection. While it is assumed early intervention will lead to control of infection in most cases, our data contradict this assumption.Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.