Betz Michael, Abrassart Sophie, Vaudaux Pierre, Gjika Ergys, Schindler Maximilian, Billières Julien, Zenelaj Besa, Suvà Domizio, Peter Robin, Uçkay Ilker
Orthopedic Surgery Service, Geneva University Hospitals & Medical School, University of Geneva, Geneva, Switzerland.
Int Orthop. 2015 Mar;39(3):397-401. doi: 10.1007/s00264-014-2510-z. Epub 2014 Sep 4.
The debridement, antibiotic and implant retention (DAIR) procedure is an option for patients with prosthetic hip joint infections for whom arthroplasty removal is problematic. Unfortunately, some of the guidelines proposed for deciding on DAIR management of arthroplasty infections fail to take into consideration the role of the infecting pathogen. While Staphylococcus aureus and streptococci are major contributors to infected hip arthroplasties, their respective contributions to treatment success or failure rates with the DAIR procedure have not been thoroughly analysed from a microbiological perspective.
This retrospective study included all patients who were hospitalised in Geneva University Hospitals between 1996 and 2012 and were initially treated with DAIR for prosthetic hip joint monomicrobial infection due to S. aureus or Streptococcus spp. The outcome of DAIR treatment was evaluated after a minimal follow-up of two years. A literature search was also performed to retrieve data from additional DAIR-treated cases in other institutions.
In our institution, 38 DAIR-treated patients with hip arthroplasty monomicrobial infections underwent at least one surgical debridement (median two, range one to five), exchange of mobile parts and concomitant targeted antibiotic therapy for several weeks or months. A literature search identified outcome data in other institutions from 52 additional DAIR-treated cases according to our study criteria. After merging our own data with those retrieved from other reports, we found a failure rate of 21 % instead of 24 % for S. aureus-infected, DAIR-treated patients, but no failure in 14 streptococcal-infected patients. In the pooled data, the failure rate linked with S. aureus infections was significantly higher than that with Streptococcus ssp. (19/90 vs 0/14 episodes; Fisher's exact test, P = 0.07).
DAIR-treated patients with prosthetic hip joint infections due to S. aureus tended to have worse outcomes than those infected with Streptococcus spp. The specific influence of the infecting pathogen should be considered in future guidelines and recommendations.
清创、抗生素及植入物保留（DAIR）手术是人工髋关节感染患者的一种选择，对于这些患者而言，关节置换移除存在问题。不幸的是，一些用于决定人工关节感染DAIR治疗的指南未能考虑感染病原体的作用。虽然金黄色葡萄球菌和链球菌是感染人工髋关节的主要病原体，但从微生物学角度来看，它们对DAIR手术治疗成功率或失败率的各自贡献尚未得到充分分析。
这项回顾性研究纳入了1996年至2012年间在日内瓦大学医院住院的所有患者，这些患者最初因金黄色葡萄球菌或链球菌属导致的人工髋关节单微生物感染接受DAIR治疗。在至少随访两年后评估DAIR治疗的结果。还进行了文献检索，以获取其他机构中额外接受DAIR治疗病例的数据。
在我们机构，38例接受DAIR治疗的人工髋关节单微生物感染患者至少接受了一次手术清创（中位数为2次，范围为1至5次），更换活动部件，并同时进行了数周或数月的靶向抗生素治疗。文献检索根据我们的研究标准在其他机构中确定了另外52例接受DAIR治疗病例的结果数据。将我们自己的数据与从其他报告中检索到的数据合并后，我们发现金黄色葡萄球菌感染且接受DAIR治疗的患者失败率为21%，而非24%，但14例链球菌感染患者无一失败。在汇总数据中，与金黄色葡萄球菌感染相关的失败率显著高于链球菌属感染（19/90例与0/14例；Fisher精确检验，P = 0.07）。
因金黄色葡萄球菌导致人工髋关节感染且接受DAIR治疗的患者往往比感染链球菌属的患者预后更差。未来的指南和建议应考虑感染病原体的具体影响。
