Rosas Samuel, Hegde Vishal, Plate F Johannes, Dennis Douglas, Jennings Jason, Bracey Daniel N
Wake Forest Baptist Health, Department of Orthopaedic Surgery, Winston-Salem, NC USA.
Colorado Joint Replacement, Denver, CO, USA.
Arthroplast Today. 2022 Jul 19;16:259-263.e1. doi: 10.1016/j.artd.2022.05.014. eCollection 2022 Aug.
Debridement, antibiotics, and implant retention (DAIR) is a common treatment for acute prosthetic joint infection (PJI). The effects of concurrent bacteremia at the time of DAIR are poorly understood. This study sought to determine whether patients with bacteremia at the time of DAIR have higher reinfection rates.
A retrospective review of a national database was performed. Patients treated with DAIR (hip or knee arthroplasty) after a diagnosis of PJI were identified. DAIR patients who also had a diagnosis of bacteremia were matched to patients without bacteremia by comorbidities and Charlson Comorbidity Index score. The primary outcome was reinfection or continued infection at 90 days and 6, 12, and 24 months after DAIR. Ninety-day Medicare charges were compared between groups. Survival probabilities were used for survival comparisons.
A total of 9945 patients underwent DAIR after a diagnosis of PJI. Seven hundred seven patients underwent DAIR with an associated diagnosis of bacteremia. Three hundred thirty-four DAIR patients with bacteremia were successfully matched to patients without bacteremia by age, gender, and comorbidities. DAIR survivorship was significantly worse in those with bacteremia at 90 days (51.5% vs 65.9%) and 6 (43.1% vs 60.5%), 12 (36.5% vs 56.0%), and 24 months (32.6% vs 53.3%) after DAIR. The 90-day costs of DAIR were significantly greater in PJI patients with bacteremia (mean: $14,722 standard deviation: $4086 vs mean: $8,052, standard deviation: $4,153, < .01).
Patients undergoing DAIR with bacteremia are at an increased risk of reinfection or continued infection. Ninety-day costs are significantly increased (over 50%) in patients with bacteremia vs those without bacteremia.
清创、抗生素治疗及植入物保留（DAIR）是急性人工关节感染（PJI）的常见治疗方法。对于DAIR治疗时并发菌血症的影响，人们了解甚少。本研究旨在确定DAIR治疗时患有菌血症的患者是否有更高的再感染率。
对一个国家数据库进行回顾性研究。确定诊断为PJI后接受DAIR（髋关节或膝关节置换术）治疗的患者。将同时诊断为菌血症的DAIR患者与无菌血症患者按合并症和查尔森合并症指数评分进行匹配。主要结局是DAIR治疗后90天以及6、12和24个月时的再感染或持续感染。比较两组之间90天的医疗保险费用。采用生存概率进行生存比较。
共有9945例患者在诊断为PJI后接受了DAIR治疗。707例患者在接受DAIR治疗时伴有菌血症诊断。334例伴有菌血症的DAIR患者按年龄、性别和合并症成功与无菌血症患者进行了匹配。在DAIR治疗后90天（51.5%对65.9%）、6个月（43.1%对60.5%）、12个月（36.可见度5%对56.0%）和24个月（32.6%对53.3%）时，菌血症患者的DAIR生存率明显更差。菌血症的PJI患者DAIR治疗90天的费用明显更高（平均值：14,722美元，标准差：4086美元；对平均值：8,052美元，标准差：4,153美元，<0.01）。
接受DAIR治疗且伴有菌血症的患者再感染或持续感染的风险增加。与无菌血症患者相比，菌血症患者90天的费用显著增加（超过50%）。
