Schenk Hendrika M, Sebillotte Marine, Lomas Jose, Taylor Adrian, Benavent Eva, Murillo Oscar, Fernandez-Sampedro Marta, Huotari Kaisa, Aboltins Craig, Trebse Rihard, Soriano Alex, Wouthuyzen-Bakker Marjan
Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands.
Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France.
J Bone Jt Infect. 2025 Jul 14;10(4):217-224. doi: 10.5194/jbji-10-217-2025. eCollection 2025.
: Patients with rheumatoid arthritis (RA) with late acute periprosthetic joint infections (PJIs) treated with surgical debridement, antibiotics, and implant retention (DAIR) have a high failure rate. We conducted a case-control study to identify risk factors for DAIR failure in this specific patient population. : Data from an international multicenter retrospective observational study were used. Late acute PJI was defined as a sudden and acute onset of PJI symptoms occurring more than 3 months after implantation in a previously asymptomatic joint. Cases with RA were matched with cases without RA based on the affected joint. A multivariate Cox regression, stratified for RA, was used to identify risk factors and calculate hazard ratios (HRs) for failure. Subgroup analysis was done to explore the role of immunosuppressive therapy. : A total of 40 patients with RA and 80 control patients without RA were included. The use or continuation of immunosuppressive drugs was not associated with a higher failure rate. No significant association was found between the duration of symptoms, causative microorganisms, and therapy failure. Bacteremia was an independent predictor for treatment failure (HR of 1.972; 95 % confidence interval, CI, of 1.088-3.573; 0.025), and the exchange of modular components was associated with a lower risk of treatment failure (HR of 0.491; 95 % CI of 0.259-0.931; ). : In patients with RA and a late acute PJI treated with DAIR, bacteremia is an important predictor of treatment failure. Exchanging the modular components seems to be especially important in this patient group and is associated with a lower failure rate.
接受手术清创、抗生素治疗及保留植入物（DAIR）的类风湿关节炎（RA）患者发生晚期急性人工关节感染（PJI）时，失败率较高。我们进行了一项病例对照研究，以确定这一特定患者群体中DAIR失败的危险因素。：使用了一项国际多中心回顾性观察研究的数据。晚期急性PJI被定义为在先前无症状的关节植入后3个月以上突然急性发作的PJI症状。基于受影响的关节，将RA患者与非RA患者进行匹配。使用针对RA分层的多变量Cox回归来确定危险因素并计算失败的风险比（HRs）。进行亚组分析以探讨免疫抑制治疗的作用。：共纳入40例RA患者和80例非RA对照患者。免疫抑制药物的使用或持续使用与较高的失败率无关。未发现症状持续时间、致病微生物与治疗失败之间存在显著关联。菌血症是治疗失败的独立预测因素（HR为1.972；95%置信区间，CI，为1.088 - 3.573；P = 0.025），模块化组件的更换与较低的治疗失败风险相关（HR为0.491；95%CI为0.259 - 0.931；P = 0.030）。：在接受DAIR治疗的RA和晚期急性PJI患者中，菌血症是治疗失败的重要预测因素。更换模块化组件在该患者群体中似乎尤为重要，且与较低的失败率相关。
