Kristensen Nicolai K, Manning Laurens, Lange Jeppe, Davis Joshua S
Department of Orthopedics, Regional Hospital of Horsens, Horsens, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Center for Planned Surgery, Regional Hospital of Silkeborg, Silkeborg, Denmark.
Medical School, University of Western Australia, Perth, Western Australia, Australia; Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia.
J Arthroplasty. 2024 Sep;39(9):2352-2356.e2. doi: 10.1016/j.arth.2024.03.070. Epub 2024 Apr 9.
Periprosthetic joint infection (PJI) is a devastating complication in hip and knee joint arthroplasty. The "Joint-Specific Bone Involvement, Antimicrobial Options, Coverage of the Soft Tissues, and Host Status (JS-BACH)" classification system was developed in 2021 to stratify the complexity of PJI, and more importantly, to act as a tool to guide referrals to specialist centers. The "JS-BACH" classification has not been validated in an external cohort. This study aimed to do so using a large prospective cohort from Australia and New Zealand.
We applied the JS-BACH classification to the Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) cohort. This prospective study of newly diagnosed PJI collected 2-year outcome data from 653 participants enrolled in 27 hospitals. The definition of PJI treatment failure at 24 months was any of the following: death, clinical or microbiological signs of infection, destination prosthesis removed, or ongoing antibiotic use. Individual cases were classified as per JS-BACH into "1: uncomplicated" (n = 268), "2: complex" (n = 330), and "3: limited options" (n = 55). This cohort was similar to the original JS-BACH population in terms of baseline characteristics. However, there was a difference in complexity, with more debridement, antibiotics, and implant retention procedures, fewer revision procedures, and a higher proportion of uncomplicated patients in the PIANO cohort.
The risk of treatment failure correlated strongly with the JS-BACH category, with odds ratios (95% confidence interval) for category 2 versus 1 of 1.75 (1.24 to 2.47) and for category 3 versus 1 of 7.12 (3.42 to 16.02).
Despite the PIANO study population being less complicated than the original derivation cohort, the JS-BACH classification showed a clear association with treatment failure in this large external cohort.
人工关节周围感染（PJI）是髋关节和膝关节置换术中一种极具破坏性的并发症。“关节特异性骨受累、抗菌药物选择、软组织覆盖及宿主状态（JS-BACH）”分类系统于2021年制定，用于对PJI的复杂性进行分层，更重要的是，作为一种工具来指导转诊至专科中心。“JS-BACH”分类尚未在外部队列中得到验证。本研究旨在利用来自澳大利亚和新西兰的大型前瞻性队列进行验证。
我们将JS-BACH分类应用于澳大利亚和新西兰人工关节感染观察（PIANO）队列。这项对新诊断的PJI的前瞻性研究收集了来自27家医院的653名参与者的2年结局数据。24个月时PJI治疗失败的定义为以下任何一种情况：死亡、感染的临床或微生物学迹象、取出目标假体或持续使用抗生素。根据JS-BACH将个体病例分为“1：不复杂”（n = 268）、“2：复杂”（n = 330）和“3：选择有限”（n = 55）。该队列在基线特征方面与原始JS-BACH人群相似。然而，在复杂性方面存在差异，PIANO队列中的清创、抗生素和植入物保留手术更多，翻修手术更少，不复杂患者的比例更高。
治疗失败的风险与JS-BACH类别密切相关，2类与1类的比值比（95%置信区间）为1.75（1.24至2.47），3类与1类的比值比为7.12（3.42至16.02）。
尽管PIANO研究人群的复杂性低于原始推导队列，但在这个大型外部队列中，JS-BACH分类与治疗失败显示出明显的关联。
