After irrigation and debridement, patients with acute hematogenous PJI yielded high failure rate
PHILADELPHIA — Patients with acute hematogenous periprosthetic joint infection experienced a higher failure rate when undergoing irrigation and debridement, according to results presented here.
Timothy L. Tan, MD, and colleagues reviewed demographics, comorbidities, clinical findings and laboratory results of 199 revision total joint arthroplasties undergoing irrigation and debridement for PJI. Researchers determined treatment failure defined by the Delphi criteria at a minimum of 1-year follow-up.
“We defined acute early postoperative PJIs within 90 days of surgery and acute hematogenous infections as more than 3 months from surgery with abrupt symptoms less than 3 weeks and this was based off the [International Consensus Meeting] ICM definition from 2013,” Tan said in his presentation at the Musculoskeletal Infection Society Annual Open Scientific Meeting.
At 1 year, Tan noted an overall treatment failure rate of 38%, with patients with acute hematogenous PJIs demonstrating a significantly higher failure rate. He added patients with acute hematogenous PJIs had a higher failure rate of 56% compared with 30% of patients with acute PJI. Patients with acute hematogenous infections tended to be older, had more comorbidities and had undergone prior knee revision, according to Tan.
“There was also a three-fold higher rate of Streptococcus species identified in cases with acute hematogenous PJI, which is consistent with the previous literature,” Tan said.
Multivariate analysis showed acute hematogenous PJI had an odds ratio of 2.5, even when controlling for potential confounders. Tan noted prior revision surgery and Charlson Comorbidity Index were predictors of failure. He added a higher risk of failure was associated with malignancy, chronic obstructive pulmonary disease and diabetes.
“We also looked at the impact of organisms and we found that antibiotic-resistant organisms and polymicrobial PJI was associated with an increased risk of failure in our [irrigation and debridement] I&D cohort,” Tan said. – by Casey Tingle
Shohat N, et al. Increased failure after irrigation and debridement for acute hematogenous PJI. Presented at: Musculoskeletal Infection Society Annual Open Scientific Meeting; July 27-28, 2018; Philadelphia.
Disclosure: Tan reports no relevant financial disclosures.