Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
J Arthroplasty. 2020 Aug;35(8):2204-2209. doi: 10.1016/j.arth.2020.02.043. Epub 2020 Feb 26.
In acute periprosthetic joint infections (PJIs), a second surgical debridement (debridement, antibiotics, and implant retention [DAIR]) is generally not recommended after a failed first one. We identified the failure rate of a second DAIR and aimed to identify patients in whom an additional debridement might still be beneficial.
Patients with acute PJI of the hip or knee and treated with DAIR between 2006 and 2016 were retrospectively evaluated. A second DAIR was routinely performed provided that the soft tissue was intact. Failure of a second DAIR was described as (1) the need for additional surgical intervention to achieve infection control, (2) the need for antibiotic suppressive therapy due to persistent clinical and/or biochemical signs of infection, or (3) PJI related death.
From the 455 cases treated with DAIR, 144 cases underwent a second debridement (34.6%). Thirty-seven cases failed (37/144, 25.7%). The implant needed to be removed in 23 cases (23/144, 16%). Positive cultures during the second DAIR (odds ratio 3.16, 95% confidence interval 1.29-7.74) and chronic renal insufficiency (odds ratio 13.6, 95% confidence interval 2.03-91.33) were independent predictors for failure in the multivariate analysis. No difference in failure was observed between persistent infection with the same microorganism and reinfection with a new microorganism (failure rate 31.6% vs 34.6%, P = .83).
A second DAIR had a low failure rate in our cohort of patients and the implant could be retained in the majority of them. Therefore, a second DAIR should not be discarded in acute PJIs.
在急性人工关节周围感染（PJI）中，初次清创、灌洗、置管引流（debridement, antibiotics, and implant retention [DAIR]）失败后，一般不建议再次行清创术。我们确定了二次 DAIR 的失败率，并旨在确定哪些患者仍可能从额外清创中获益。
回顾性评估了 2006 年至 2016 年间接受 DAIR 治疗的髋或膝关节急性 PJI 患者。只要软组织完整，通常会进行第二次 DAIR。如果出现以下情况，则认为二次 DAIR 失败：（1）需要进一步手术干预以控制感染；（2）由于持续的临床和/或生化感染迹象，需要抗生素抑制治疗；（3）与 PJI 相关的死亡。
在接受 DAIR 治疗的 455 例患者中，有 144 例接受了第二次清创术（34.6%）。37 例（37/144，25.7%）失败。23 例（23/144，16%）需要取出植入物。二次 DAIR 时的阳性培养物（比值比 3.16，95%置信区间 1.29-7.74）和慢性肾功能不全（比值比 13.6，95%置信区间 2.03-91.33）是多变量分析中的独立预测因素。在相同微生物持续感染和新微生物再感染之间，失败率无差异（31.6% vs 34.6%，P =.83）。
在我们的患者队列中，二次 DAIR 的失败率较低，大多数患者可以保留植入物。因此，急性 PJI 不应放弃二次 DAIR。
