Gerritsen Laura M, Scheper Henk, de Boer Mark G J, Schoones Jan W, Nelissen Rob G H H, Pijls Bart G C
Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, J-11-R-83, Leiden 2333 ZA, The Netherlands.
Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands.
Surg Pract Sci. 2023 Jul 16;14:100201. doi: 10.1016/j.sipas.2023.100201. eCollection 2023 Sep.
This systematic review and meta-analysis was conducted to assess the outcome of streptococcal hip and knee prosthetic joint infection (PJI) treated with Debridement, Antibiotics and Implant Retention (DAIR) and to evaluate risk factors associated with failure.
We conducted a systematic literature search on PubMed, Embase, Web of Science, and Cochrane library from inception until October 2021. Random effects meta-analyses (i.e. relative risk) were used to estimate the success rate at the study level and its association with possible risk factors for failure with a specific focus on the use of rifampicin.
25 observational studies were included, incorporating 1367 patients with streptococcal PJIs treated with DAIR. An overall pooled success rate of 71% (95% confidence interval (95%CI) 64-77%) was found for streptococcal PJI treated with DAIR. Treatment success was 76% (95%CI 62% to 91%) for knee PJI and 58% (95%CI 52% to 65%) for hip PJI. Treatment success differed for patients receiving rifampicin (84%, 95% CI 78% to 90%) compared to patients not receiving rifampicin (74%, 95% CI 63% to 85%), but this effect was no longer present in subsequent meta-analyses.
The meta-analysis showed no clear benefit for rifampicin administration after DAIR for streptococcal PJI. Better outcome was observed for knee PJI compared to hip PJI.
PROSPERO注册号：367411。
本系统评价和荟萃分析旨在评估清创、抗生素及保留植入物（DAIR）治疗链球菌性髋和膝关节假体周围感染（PJI）的疗效，并评估与治疗失败相关的危险因素。
我们在PubMed、Embase、Web of Science和Cochrane图书馆进行了一项系统文献检索，检索时间从建库至2021年10月。采用随机效应荟萃分析（即相对风险）来估计研究水平的成功率及其与可能的失败危险因素的关联，特别关注利福平的使用情况。
纳入了25项观察性研究，共1367例接受DAIR治疗的链球菌性PJI患者。DAIR治疗链球菌性PJI的总体合并成功率为71%（95%置信区间（95%CI）64 - 77%）。膝关节PJI的治疗成功率为76%（95%CI 62%至91%），髋关节PJI为58%（95%CI 52%至65%）。接受利福平治疗的患者治疗成功率为84%（95%CI 78%至90%），未接受利福平治疗的患者为74%（95%CI 63%至8
