Risk Factors of DAIR Failure and Validation of the KLIC Score: A Multicenter Study of Four Hundred Fifty-Five Patients

Bernaus, Martí; Auñón, Álvaro; Monfort-Mira, Montserrat; Arteagoitia-Colino, Iraia; Martínez-Ros, Javier; Castellanos, Juan; Lamo-Espinosa, José María; Argüelles, Francisco; Veloso, Margarita; García, Lucía Gómez; Crespo, F. Anglès; Sánchez-Fernández, Joel; Murias-Alvarez, J.; Martí-Garín, David; Hernández-Gonzalez, Nerea; Villarejo-Fernández, Borja; Valero-Cifuentes, Gregorio; Hernández-Torres, Alícia; Molina-González, José; Coifman-Lucena, Ismael; Esteban-Moreno, Jaime; Demaria, Pablo; Esteve-Palau, Erika; Pozo, José Luís del; Suárez, Álvaro; Carmona-Torre, Francisco; Darás, Álvaro; Baeza, J.A.; Font-Vizcarra, Lluís

doi:10.1089/sur.2021.320

Cited by 5 publications

(2 citation statements)

References 25 publications

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“…Patients without high-risk features—such as S aureus infection, knee PJI, late acute infection, chronic kidney disease, revision arthroplasty, and cemented arthroplasty—have the least benefit for SAT. This is consistent with previous literature reporting that these are risk factors for treatment failure in DAIR [ 16 ]. Note that most of these studies analyzed the risk factors for patients whose treatment had already failed during antibiotic therapy.…”

Section: Discussionsupporting

confidence: 93%

Role of Routine Suppressive Antibiotic Therapy After Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infections

Tai,

Tande,

Langworthy

et al. 2024

Open Forum Infectious Diseases

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Background Debridement, antibiotics, irrigation, and implant retention (DAIR) is the first-line management strategy for acute periprosthetic joint infections (PJI). Suppressive antibiotic therapy (SAT) after DAIR is proposed to improve outcomes, yet its efficacy remains under scrutiny. Methods We conducted a multicenter retrospective study in patients with acute PJI of the hip or knee and treated with DAIR in centers from Europe and the USA. We analyzed the effect of SAT using a Cox model landmarked at 12 weeks. The primary covariate of interest was SAT, which was analyzed as a time-varying covariate. Patients who experienced treatment failure or lost to follow-up within 12 weeks were excluded from the analysis. Results The study included 510 patients with 66 treatment failures with a median follow-up of 801 days. We did not find a statistically significant association between SAT and treatment failure (HR 1.37, 95% CI 0.79-2.39, p=0.27). Subgroup analyses for joint, country cohort, and type of infection (early or late acute) did not show benefit for SAT. Secondary analysis of country cohorts showed a trend toward benefit for the USA cohort (HR 0.36, 95% CI 0.11-1.15, p=0.09) which also had the highest risk of treatment failure. Conclusion The utility of routine SAT as a strategy for enhancing DAIR's success in acute PJI remains uncertain. Our results suggest that SAT's benefits might be restricted to specific groups of patients, underscoring the need for randomized controlled trials. Identifying patients most likely to benefit from SAT should be a priority in future studies.

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Section: Discussionsupporting

confidence: 93%

Role of Routine Suppressive Antibiotic Therapy After Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infections

Tai,

Tande,

Langworthy

et al. 2024

Open Forum Infectious Diseases

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show abstract

“…With these premises in mind, in 2015, Tornero et al [ 9 ] developed a score called the Kidney, Liver, Index surgery, Cemented prosthesis and C-reactive protein value (KLIC) intended to predict failure among patients who underwent DAIR for EAPJI. The score was subsequently externally validated by other authors [ 23 , 25 , 26 , 27 , 28 ]. Sometime later, the European Study Group for Implant-Associated Infections (ESGIAI) developed another score specifically applicable to LAPJI [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of a Novel Preoperative Failure Risk Model for Debridement Antibiotics and Implant Retention (DAIR) in Acute Prosthetic Joint Infection

et al. 2022

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Given the variable success of the debridement, antibiotics and implant retention (DAIR) procedure in patients with acute prosthetic joint infection (PJI), an accurate selection of candidates is critical. In this study, we set about calculating the predictive value of a novel algorithm for predicting outcome following DAIR developed by Shohat et al. Sixty-four patients who underwent debridement for (early and late) acute PJI in a tertiary-level university hospital were selected, and the aforementioned algorithm was retrospectively applied. Patients with model scores of 40–50%, 50–60%, 60–70%, 70–80% and 80–90% displayed success rates of 33.34%, 41.18%, 57.9%, 78.27% and 100%, respectively. The receiver operating characteristic curve showed an area under the curve of 0.69. The calibration intercept value was 0, and the calibration slope value was 1. Failure rates were significantly higher for the following variables: revision surgery (p = 0.012) index surgery for reasons other than osteoarthritis (p = 0.01), and C-reactive protein level >30 mg/L (p = 0.042). This analysis demonstrated that the Shohat algorithm is associated with an optimal calibration value and a moderate predictive value for failure of a DAIR procedure in patients with acute PJI. Its validation is recommended before it can be routinely applied in daily practice.

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Synovectomie–lavage et changement de pièces intermédiaires (SYLAC) pour infections précoces de PTG

Boyer,

Cazorla,

Carricajo

2023

Quand Et Comment Reprendre Une Prothèse De Genou ?

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Risk Factors of DAIR Failure and Validation of the KLIC Score: A Multicenter Study of Four Hundred Fifty-Five Patients

Cited by 5 publications

References 25 publications

Role of Routine Suppressive Antibiotic Therapy After Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infections

Role of Routine Suppressive Antibiotic Therapy After Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infections

Accuracy of a Novel Preoperative Failure Risk Model for Debridement Antibiotics and Implant Retention (DAIR) in Acute Prosthetic Joint Infection

Synovectomie–lavage et changement de pièces intermédiaires (SYLAC) pour infections précoces de PTG

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