What’s New in Musculoskeletal Infection: Update Across Orthopaedic Subspecialties

Chen, Antonia F.; Nana, Arvind; Nelson, Sandra; McLaren, A. C.

doi:10.2106/jbjs.17.00421

Cited by 12 publications

(3 citation statements)

References 112 publications

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“…Several previous studies have reported that a shorter duration of symptoms was related to the eradication of infection ( 28 – 31 ). Surgical debridement and subsequent continuous antibiotics may remove planktonic bacteria and younger biofilm ( 32 ). A longer duration of symptoms theoretically indicates higher rates of biofilm formation and may explain why a longer duration of symptoms infers higher failure from DAIR.…”

Section: Discussionmentioning

confidence: 99%

Symptom duration is associated with failure of periprosthetic joint infection treated with debridement, antibiotics and implant retention

Shao

Li²,

Wang³

et al. 2022

Front. Surg.

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BackgroundDebridement, antibiotics, and implant retention (DAIR) is an alternative treatment strategy for periprosthetic joint infection (PJI). However, no consensus exists regarding which patient population(s) may be most suitable for DAIR. This study aims to investigate the overall infection control rate and explore the prognostic factors associated with acute, hematogenous, and chronic PJIs treated with DAIR.MethodsWe retrospectively reviewed the included patients who were diagnosed with PJI and underwent DAIR at two institutions from 2009 to 2018 (n = 104). We collected the clinical data, including demographics, preoperative laboratory tests, Charlson Comorbidity Index, surgical information, and culture organism results. Treatment success was defined according to the criteria reported by Diaz-Ledezma. All patients were followed for at least one year unless failure preceded that time point. A multivariable analysis was utilized to identify prognostic factors associated with treatment, and a Kaplan-Meier survival analysis was used to depict the infection control rate.ResultsThe overall treatment success rate in the current cohort of patients was 67.3% at a median 38.6 (interquartile range: 23.5, 90.7) months follow-up. Patients with a duration of infectious symptoms of more than ten days were more likely to fail (P = 0.035, hazard ratio 8.492, 95% confidence interval 1.159–62.212). There was no difference among acute, hematogenous, and chronic infections in terms of failure rate (P = 0.161).ConclusionsDAIR is a reasonable treatment option for PJI, and its use in the setting of chronic infection does not appear to be a contraindication. Performing DAIR within ten days of the presentation of symptoms had a higher rate of treatment success.

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Section: Discussionmentioning

confidence: 99%

Symptom duration is associated with failure of periprosthetic joint infection treated with debridement, antibiotics and implant retention

Shao

Li²,

Wang³

et al. 2022

Front. Surg.

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“…Although two-stage exchange 52 has long been considered the gold standard treatment strategy for chronic PJI in the United States, failure rates up to 30% have been reported. [53][54][55][56][57] With the goal of improving these outcomes and minimizing reinfection, some studies have evaluated EOAP after exchange arthroplasty (Table 1).…”

Section: Extended Oral Antibiotic Prophylaxis After Successful Treatm...mentioning

confidence: 99%

How are Oral Antibiotics Being Used in Total Joint Arthroplasty? A Review of the Literature

Weiner,

El-Najjar,

Herndon

et al. 2024

Orthopedic Reviews

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While the role and benefit of perioperative intravenous (IV) antibiotics in patients undergoing total joint arthroplasty (TJA) is well-established, oral antibiotic use in TJA remains a controversial topic with wide variations in practice patterns. With this review, we aimed to better educate the orthopedic surgeon on when and how oral antibiotics may be used most effectively in TJA patients, and to identify gaps in the literature that could be clarified with targeted research. Extended oral antibiotic prophylaxis (EOAP) use in high-risk primary, aseptic revision, and exchange TJA for infection may be useful in decreasing periprosthetic joint infection (PJI) rates. When prescribing oral antibiotics either as EOAP or for draining wounds, patient factors, type of surgery, and type of infectious organisms should be considered in order to optimally prevent and treat PJI. It is important to maintain antibiotic stewardship by administering the proper duration, dose, and type of antibiotics and by consulting infectious disease when necessary.

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“…A 2-stage revision involves the removal of all implants, irrigation and debridement of all infected tissues, implantation of an antibiotic-impregnated spacer, parenteral administration of microorganism-directed antibiotics for 6 weeks, and reimplantation when the initial infection is deemed to have been adequately treated [ [15] , [16] , [17] , [18] ]. Despite this extensive process, failure rates as high as 34% have been reported, and the etiologies of failures secondary to infection remain unknown [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Recurrent Failures After 2-Stage Exchanges are Secondary to New Organisms Not Previously Covered by Antibiotics

Egbulefu¹,

Yang²,

Segreti³

et al. 2022

Arthroplasty Today

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What’s New in Musculoskeletal Infection: Update Across Orthopaedic Subspecialties

Abstract: Specialty Update has been developed in collaboration with the Board of Specialty Societies (BOS) of the American Academy of Orthopaedic Surgeons.

Cited by 12 publications

References 112 publications

Symptom duration is associated with failure of periprosthetic joint infection treated with debridement, antibiotics and implant retention

Symptom duration is associated with failure of periprosthetic joint infection treated with debridement, antibiotics and implant retention

How are Oral Antibiotics Being Used in Total Joint Arthroplasty? A Review of the Literature

Recurrent Failures After 2-Stage Exchanges are Secondary to New Organisms Not Previously Covered by Antibiotics

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