Polymicrobial prosthetic joint infections managed with surgical debridement, antibiotics and implant retention (DAIR) had high readmission rates and deep surgical site infections (SSI), according to research presented at IDWeek 2019, held from October 2 to October 6, 2019 in Washington, DC, Maryland.

In this retrospective study, patients’ electronic medical records were reviewed from 3 Ascension hospitals in Detroit from January 2012 to December 2018 to assess clinical outcomes of polymicrobial prosthetic joint infections managed with DAIR.

Researchers identified 26 patients (mean age, 66 years; 19 Caucasians; 18 women) with polymicrobial prosthetic joint infections managed with DAIR. Infected sites were hip, knee, and ankle (15, 10, and 1, respectively). Majority of the patients had osteoarthritis (n=22).  

Fourteen patients had symptom onset of less than a week, and 8 patients had symptom onset in 3 or more week. Pain, swelling and drainage were present in 21 (81%), 13 (50%) and 18 (69%) cases, respectively. Fever on admission was noted in 7 patients. Eleven patients were readmitted within the following 12 months after DAIR. Superficial and deep surgical site infections developed in 2 (19%) and 9 (81%) patients, respectively.

Implant removal was needed in 6 (55%) patients. Five patients (2 with superficial surgical site infections; 3 with deep surgical site infections) required further debridement and antibiotics.

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Good outcomes were noted in 5 patients who received 3 to 6 months of antibiotic treatments. Three patients required long term chronic suppressive therapy. One patient died from a cardiac event during follow up.

“DAIR failures, noted in 23% of our cases, required implant removal within 12 months of follow up,” stated the researchers.

Reference

Hooshmand B, Youssef D, Riederer KM, Szpunar SM, Bhargava A. Clinical outcome of polymicrobial prosthetic joint infection managed with debridement, antibiotics and implant retention (DAIR). Presented at: IDWeek 2019; October 2-6, 2019; Washington, DC, MD. Poster 381.