Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
J Antimicrob Chemother. 2018 Dec 1;73(12):3454-3459. doi: 10.1093/jac/dky354.
Early acute periprosthetic joint infections (PJIs) treated with debridement, antibiotics and implant retention (DAIR) have failure rates ranging from 10% to 60%. We determined the efficacy of applying local gentamicin-impregnated beads and/or sponges during debridement in early PJI.
Patients with early acute PJI, defined as less than 21 days of symptoms and treated with DAIR within 90 days after index surgery, were retrospectively evaluated. Early failure was defined as PJI-related death, the need for implant removal or a second DAIR or antibiotic suppressive therapy owing to persistent signs of infection, all within 60 days after initial debridement. Overall failure was defined as implant removal at any timepoint during follow-up. A 1:1 propensity score matching was performed to correct for confounding factors.
A total of 386 patients were included. Local gentamicin was applied in 293 patients (75.9%) and was withheld in 93 patients (24.1%). Multivariate analysis demonstrated that the use of local gentamicin was independently associated with early failure (OR = 1.97, 95% CI = 1.12-3.48). After propensity matching, early failure was 40.3% in the gentamicin group versus 26.0% in the control group (P = 0.06) and overall failure was 5.2% in the gentamicin group versus 2.6% in the control group (P = 0.40). These numbers remained when solely analysing the application of gentamicin-impregnated sponges.
Even after propensity score matching, failure rates remained higher if local gentamicin-impregnated beads and/or sponges were administered in early acute PJI. Based on these results, their use should be discouraged.
采用清创术、抗生素和保留假体（DAIR）治疗的早期急性人工关节周围感染（PJI）的失败率为 10%至 60%。我们确定了在早期 PJI 清创术中应用局部庆大霉素浸渍珠和/或海绵的疗效。
回顾性评估了早期急性 PJI 患者，定义为症状少于 21 天，且在指数手术后 90 天内接受 DAIR 治疗。早期失败定义为与 PJI 相关的死亡、需要去除假体或因持续感染迹象而进行第二次 DAIR 或抗生素抑制治疗，所有这些均发生在初次清创术后 60 天内。总失败定义为在随访期间的任何时间点去除假体。进行 1:1 倾向评分匹配以纠正混杂因素。
共纳入 386 例患者。293 例（75.9%）患者应用了局部庆大霉素，93 例（24.1%）患者未应用。多变量分析表明，使用局部庆大霉素与早期失败独立相关（OR=1.97，95%CI=1.12-3.48）。在倾向评分匹配后，庆大霉素组的早期失败率为 40.3%，对照组为 26.0%（P=0.06），总失败率庆大霉素组为 5.2%，对照组为 2.6%（P=0.40）。当仅分析庆大霉素浸渍海绵的应用时，这些数字仍然存在。
即使在进行倾向评分匹配后，如果在早期急性 PJI 中应用局部庆大霉素浸渍珠和/或海绵，失败率仍然较高。基于这些结果，应避免使用。
