Davis Joshua S, Metcalf Sarah, Clark Benjamin, Robinson J Owen, Huggan Paul, Luey Chris, McBride Stephen, Aboltins Craig, Nelson Renjy, Campbell David, Solomon L Bogdan, Schneider Kellie, Loewenthal Mark R, Yates Piers, Athan Eugene, Cooper Darcie, Rad Babak, Allworth Tony, Reid Alistair, Read Kerry, Leung Peter, Sud Archana, Nagendra Vana, Chean Roy, Lemoh Chris, Mutalima Nora, Tran Ton, Grimwade Kate, Sehu Marjoree, Looke David, Torda Adrienne, Aung Thi, Graves Steven, Paterson David L, Manning Laurens
Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.
Department of Infectious Diseases, John Hunter Hospital, Newcastle, New South Wales, Australia.
Open Forum Infect Dis. 2022 Feb 2;9(3):ofac048. doi: 10.1093/ofid/ofac048. eCollection 2022 Mar.
Periprosthetic joint infection (PJI) is a devastating condition and there is a lack of evidence to guide its management. We hypothesized that treatment success is independently associated with modifiable variables in surgical and antibiotic management.
The is a prospective, observational study at 27 hospitals across Australia and New Zealand. Newly diagnosed large joint PJIs were eligible. Data were collected at baseline and at 3, 12, and 24 months. The main outcome measures at 24 months were clinical cure (defined as all of the following: alive, absence of clinical or microbiological evidence of infection, and not requiring ongoing antibiotic therapy) and treatment success (clinical cure plus index prosthesis still in place).
Twenty-four-month outcome data were available for 653 patients. Overall, 449 patients (69%) experienced clinical cure and 350 (54%) had treatment success. The most common treatment strategy was debridement and implant retention (DAIR), with success rates highest in early postimplant infections (119 of 160, 74%) and lower in late acute (132 of 267, 49%) and chronic (63 of 142, 44%) infections. Selected comorbidities, knee joint, and infections were independently associated with treatment failure, but antibiotic choice and duration (including rifampicin use) and extent of debridement were not.
Treatment success in PJI is associated with (1) selecting the appropriate treatment strategy and (2) nonmodifiable patient and infection factors. Interdisciplinary decision making that matches an individual patient to an appropriate management strategy is a critical step for PJI management. Randomized controlled trials are needed to determine the role of rifampicin in patients managed with DAIR and the optimal surgical strategy for late-acute PJI.
人工关节周围感染（PJI）是一种严重的疾病，目前缺乏指导其治疗的证据。我们假设治疗成功与手术和抗生素治疗中的可改变变量独立相关。
这是一项在澳大利亚和新西兰27家医院进行的前瞻性观察研究。新诊断的大关节PJI患者符合条件。在基线以及3个月、12个月和24个月时收集数据。24个月时的主要结局指标为临床治愈（定义为以下所有情况：存活、无感染的临床或微生物学证据且无需持续抗生素治疗）和治疗成功（临床治愈加植入的假体仍在位）。
653例患者有24个月的结局数据。总体而言，449例患者（69%）实现了临床治愈，350例（54%）获得了治疗成功。最常见的治疗策略是清创并保留植入物（DAIR），早期植入后感染的成功率最高（160例中的119例，74%），晚期急性感染（267例中的132例，49%）和慢性感染（142例中的63例，44%）的成功率较低。选定的合并症、膝关节和感染与治疗失败独立相关，但抗生素的选择和使用时长（包括利福平的使用）以及清创范围则无关。
PJI的治疗成功与（1）选择合适的治疗策略以及（2）不可改变的患者和感染因素有关。将个体患者与合适的管理策略相匹配的多学科决策是PJI管理的关键步骤。需要进行随机对照试验来确定利福平在接受DAIR治疗的患者中的作用以及晚期急性PJI的最佳手术策略。
