Predictors of treatment outcome in prosthetic joint infections treated with prosthesis retention
Purpose The reported success rates of debridement, antibiotics, and implant retention (DAIR) for prosthetic joint infections (PJIs) vary widely. Several risk factors have been described for treatment failure, but they vary between studies. The purpose of this study was to evaluate the predictors of...
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| Veröffentlicht in: | International orthopaedics 2015-09, Vol.39 (9), p.1785-1791 |
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| creator | Puhto, Ari-Pekka Puhto, Teija Niinimäki, Tuukka Ohtonen, Pasi Leppilahti, Juhana Syrjälä, Hannu |
| description | Purpose
The reported success rates of debridement, antibiotics, and implant retention (DAIR) for prosthetic joint infections (PJIs) vary widely. Several risk factors have been described for treatment failure, but they vary between studies. The purpose of this study was to evaluate the predictors of DAIR failure in PJI treatment and to assess the efficacy of rifampin combined with ciprofloxacin versus rifampin combined with other antibiotics in staphylococcal PJIs.
Methods
Patients with PJI that underwent DAIR for the first time between February 2001 and August 2009 were identified retrospectively in the hospital’s patient databases. A total of 113 PJI cases with early postoperative or acute haematogenous PJI were followed for up to two years from the start of treatment.
Results
In univariate analysis, variables significantly associated with treatment failure were acute haematogenous infections (
p
= 0.022), leucocyte count at admission > 10 × 10
9
/l (
p
|
| doi_str_mv | 10.1007/s00264-015-2819-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1708161987</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1708161987</sourcerecordid><originalsourceid>FETCH-LOGICAL-c414t-439a8ff0368da049ceaec8ce6f0e8cf613cd433fe0897334947e69ee60dd01ab3</originalsourceid><addsrcrecordid>eNp9kD1vHCEURVFkK147-QFpoindjPMesAyU0Sr-kCwlhV3jWeaRZbUzbIBR5H9vrLFTpqJ4515dDmNfEK4QoPuWAbiSLeC65RpNyz-wFUrB2zWa9QlbgZDYcmXWZ-w85z0AdkrjR3bGFQrddXzFnn4lGoIrMeUm-qYk6stIU2niXFwcqQlTc0wxlx2V4Jp9DPUWJk-uhDjlJUBD8zeU3TuYQ24SldpSkU_s1PeHTJ_f3gv2eP3jYXPb3v-8udt8v2-dRFlaKUyvvQeh9NCDNI56ctqR8kDa-brXDVIIT6BNJ4Q0siNliBQMA2C_FRfscumtI_7MlIsdQ3Z0OPQTxTlb7ECjQqO7iuKCuro3J_L2mMLYp2eLYF_F2kWsrWLtq1jLa-brW_28HWn4l3g3WQG-ALmept-U7D7Oaapf_k_rC8krhf0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1708161987</pqid></control><display><type>article</type><title>Predictors of treatment outcome in prosthetic joint infections treated with prosthesis retention</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Puhto, Ari-Pekka ; Puhto, Teija ; Niinimäki, Tuukka ; Ohtonen, Pasi ; Leppilahti, Juhana ; Syrjälä, Hannu</creator><creatorcontrib>Puhto, Ari-Pekka ; Puhto, Teija ; Niinimäki, Tuukka ; Ohtonen, Pasi ; Leppilahti, Juhana ; Syrjälä, Hannu</creatorcontrib><description>Purpose
The reported success rates of debridement, antibiotics, and implant retention (DAIR) for prosthetic joint infections (PJIs) vary widely. Several risk factors have been described for treatment failure, but they vary between studies. The purpose of this study was to evaluate the predictors of DAIR failure in PJI treatment and to assess the efficacy of rifampin combined with ciprofloxacin versus rifampin combined with other antibiotics in staphylococcal PJIs.
Methods
Patients with PJI that underwent DAIR for the first time between February 2001 and August 2009 were identified retrospectively in the hospital’s patient databases. A total of 113 PJI cases with early postoperative or acute haematogenous PJI were followed for up to two years from the start of treatment.
Results
In univariate analysis, variables significantly associated with treatment failure were acute haematogenous infections (
p
= 0.022), leucocyte count at admission > 10 × 10
9
/l (
p
< 0.01), pain in the joint (
p
< 0.01), and ineffective empirical antibiotics (
p
< 0.01). In a multivariate Cox model, leucocyte count > 10 × 10
9
/l and ineffective empirical antibiotics were significant risk factors for failure. Compared to rifampin-ciprofloxacin, the hazard ratio (HR) for treatment failure was significantly increased in the rifampin-other antibiotics group (HR 6.0, 95 % CI 1.5−28.8,
p
= 0.014) and the group treated without rifampin (HR 14.4, 95 % CI 3.1−66.9,
p
< 0.01).
Conclusions
Rifampin-ciprofloxacin combination therapy was significantly more effective than rifampin combined with other antibiotics. Effective empirical antibiotics are essential for successful PJI treatment.</description><identifier>ISSN: 0341-2695</identifier><identifier>EISSN: 1432-5195</identifier><identifier>DOI: 10.1007/s00264-015-2819-2</identifier><identifier>PMID: 26138772</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - therapeutic use ; Ciprofloxacin - therapeutic use ; Debridement ; Drug Therapy, Combination ; Female ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Paper ; Orthopedics ; Prosthesis Retention ; Prosthesis-Related Infections - drug therapy ; Prosthesis-Related Infections - microbiology ; Prosthesis-Related Infections - surgery ; Prosthesis-Related Infections - therapy ; Retrospective Studies ; Rifampin - therapeutic use ; Risk Factors ; Treatment Failure ; Treatment Outcome</subject><ispartof>International orthopaedics, 2015-09, Vol.39 (9), p.1785-1791</ispartof><rights>SICOT aisbl 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-439a8ff0368da049ceaec8ce6f0e8cf613cd433fe0897334947e69ee60dd01ab3</citedby><cites>FETCH-LOGICAL-c414t-439a8ff0368da049ceaec8ce6f0e8cf613cd433fe0897334947e69ee60dd01ab3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00264-015-2819-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00264-015-2819-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26138772$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Puhto, Ari-Pekka</creatorcontrib><creatorcontrib>Puhto, Teija</creatorcontrib><creatorcontrib>Niinimäki, Tuukka</creatorcontrib><creatorcontrib>Ohtonen, Pasi</creatorcontrib><creatorcontrib>Leppilahti, Juhana</creatorcontrib><creatorcontrib>Syrjälä, Hannu</creatorcontrib><title>Predictors of treatment outcome in prosthetic joint infections treated with prosthesis retention</title><title>International orthopaedics</title><addtitle>International Orthopaedics (SICOT)</addtitle><addtitle>Int Orthop</addtitle><description>Purpose
The reported success rates of debridement, antibiotics, and implant retention (DAIR) for prosthetic joint infections (PJIs) vary widely. Several risk factors have been described for treatment failure, but they vary between studies. The purpose of this study was to evaluate the predictors of DAIR failure in PJI treatment and to assess the efficacy of rifampin combined with ciprofloxacin versus rifampin combined with other antibiotics in staphylococcal PJIs.
Methods
Patients with PJI that underwent DAIR for the first time between February 2001 and August 2009 were identified retrospectively in the hospital’s patient databases. A total of 113 PJI cases with early postoperative or acute haematogenous PJI were followed for up to two years from the start of treatment.
Results
In univariate analysis, variables significantly associated with treatment failure were acute haematogenous infections (
p
= 0.022), leucocyte count at admission > 10 × 10
9
/l (
p
< 0.01), pain in the joint (
p
< 0.01), and ineffective empirical antibiotics (
p
< 0.01). In a multivariate Cox model, leucocyte count > 10 × 10
9
/l and ineffective empirical antibiotics were significant risk factors for failure. Compared to rifampin-ciprofloxacin, the hazard ratio (HR) for treatment failure was significantly increased in the rifampin-other antibiotics group (HR 6.0, 95 % CI 1.5−28.8,
p
= 0.014) and the group treated without rifampin (HR 14.4, 95 % CI 3.1−66.9,
p
< 0.01).
Conclusions
Rifampin-ciprofloxacin combination therapy was significantly more effective than rifampin combined with other antibiotics. Effective empirical antibiotics are essential for successful PJI treatment.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Ciprofloxacin - therapeutic use</subject><subject>Debridement</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Paper</subject><subject>Orthopedics</subject><subject>Prosthesis Retention</subject><subject>Prosthesis-Related Infections - drug therapy</subject><subject>Prosthesis-Related Infections - microbiology</subject><subject>Prosthesis-Related Infections - surgery</subject><subject>Prosthesis-Related Infections - therapy</subject><subject>Retrospective Studies</subject><subject>Rifampin - therapeutic use</subject><subject>Risk Factors</subject><subject>Treatment Failure</subject><subject>Treatment Outcome</subject><issn>0341-2695</issn><issn>1432-5195</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kD1vHCEURVFkK147-QFpoindjPMesAyU0Sr-kCwlhV3jWeaRZbUzbIBR5H9vrLFTpqJ4515dDmNfEK4QoPuWAbiSLeC65RpNyz-wFUrB2zWa9QlbgZDYcmXWZ-w85z0AdkrjR3bGFQrddXzFnn4lGoIrMeUm-qYk6stIU2niXFwcqQlTc0wxlx2V4Jp9DPUWJk-uhDjlJUBD8zeU3TuYQ24SldpSkU_s1PeHTJ_f3gv2eP3jYXPb3v-8udt8v2-dRFlaKUyvvQeh9NCDNI56ctqR8kDa-brXDVIIT6BNJ4Q0siNliBQMA2C_FRfscumtI_7MlIsdQ3Z0OPQTxTlb7ECjQqO7iuKCuro3J_L2mMLYp2eLYF_F2kWsrWLtq1jLa-brW_28HWn4l3g3WQG-ALmept-U7D7Oaapf_k_rC8krhf0</recordid><startdate>20150901</startdate><enddate>20150901</enddate><creator>Puhto, Ari-Pekka</creator><creator>Puhto, Teija</creator><creator>Niinimäki, Tuukka</creator><creator>Ohtonen, Pasi</creator><creator>Leppilahti, Juhana</creator><creator>Syrjälä, Hannu</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150901</creationdate><title>Predictors of treatment outcome in prosthetic joint infections treated with prosthesis retention</title><author>Puhto, Ari-Pekka ; Puhto, Teija ; Niinimäki, Tuukka ; Ohtonen, Pasi ; Leppilahti, Juhana ; Syrjälä, Hannu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-439a8ff0368da049ceaec8ce6f0e8cf613cd433fe0897334947e69ee60dd01ab3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Ciprofloxacin - therapeutic use</topic><topic>Debridement</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Paper</topic><topic>Orthopedics</topic><topic>Prosthesis Retention</topic><topic>Prosthesis-Related Infections - drug therapy</topic><topic>Prosthesis-Related Infections - microbiology</topic><topic>Prosthesis-Related Infections - surgery</topic><topic>Prosthesis-Related Infections - therapy</topic><topic>Retrospective Studies</topic><topic>Rifampin - therapeutic use</topic><topic>Risk Factors</topic><topic>Treatment Failure</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Puhto, Ari-Pekka</creatorcontrib><creatorcontrib>Puhto, Teija</creatorcontrib><creatorcontrib>Niinimäki, Tuukka</creatorcontrib><creatorcontrib>Ohtonen, Pasi</creatorcontrib><creatorcontrib>Leppilahti, Juhana</creatorcontrib><creatorcontrib>Syrjälä, Hannu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International orthopaedics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Puhto, Ari-Pekka</au><au>Puhto, Teija</au><au>Niinimäki, Tuukka</au><au>Ohtonen, Pasi</au><au>Leppilahti, Juhana</au><au>Syrjälä, Hannu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of treatment outcome in prosthetic joint infections treated with prosthesis retention</atitle><jtitle>International orthopaedics</jtitle><stitle>International Orthopaedics (SICOT)</stitle><addtitle>Int Orthop</addtitle><date>2015-09-01</date><risdate>2015</risdate><volume>39</volume><issue>9</issue><spage>1785</spage><epage>1791</epage><pages>1785-1791</pages><issn>0341-2695</issn><eissn>1432-5195</eissn><abstract>Purpose
The reported success rates of debridement, antibiotics, and implant retention (DAIR) for prosthetic joint infections (PJIs) vary widely. Several risk factors have been described for treatment failure, but they vary between studies. The purpose of this study was to evaluate the predictors of DAIR failure in PJI treatment and to assess the efficacy of rifampin combined with ciprofloxacin versus rifampin combined with other antibiotics in staphylococcal PJIs.
Methods
Patients with PJI that underwent DAIR for the first time between February 2001 and August 2009 were identified retrospectively in the hospital’s patient databases. A total of 113 PJI cases with early postoperative or acute haematogenous PJI were followed for up to two years from the start of treatment.
Results
In univariate analysis, variables significantly associated with treatment failure were acute haematogenous infections (
p
= 0.022), leucocyte count at admission > 10 × 10
9
/l (
p
< 0.01), pain in the joint (
p
< 0.01), and ineffective empirical antibiotics (
p
< 0.01). In a multivariate Cox model, leucocyte count > 10 × 10
9
/l and ineffective empirical antibiotics were significant risk factors for failure. Compared to rifampin-ciprofloxacin, the hazard ratio (HR) for treatment failure was significantly increased in the rifampin-other antibiotics group (HR 6.0, 95 % CI 1.5−28.8,
p
= 0.014) and the group treated without rifampin (HR 14.4, 95 % CI 3.1−66.9,
p
< 0.01).
Conclusions
Rifampin-ciprofloxacin combination therapy was significantly more effective than rifampin combined with other antibiotics. Effective empirical antibiotics are essential for successful PJI treatment.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>26138772</pmid><doi>10.1007/s00264-015-2819-2</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0341-2695 |
| ispartof | International orthopaedics, 2015-09, Vol.39 (9), p.1785-1791 |
| issn | 0341-2695 1432-5195 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1708161987 |
| source | MEDLINE; Springer Nature - Complete Springer Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Adult Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use Ciprofloxacin - therapeutic use Debridement Drug Therapy, Combination Female Humans Male Medicine Medicine & Public Health Middle Aged Original Paper Orthopedics Prosthesis Retention Prosthesis-Related Infections - drug therapy Prosthesis-Related Infections - microbiology Prosthesis-Related Infections - surgery Prosthesis-Related Infections - therapy Retrospective Studies Rifampin - therapeutic use Risk Factors Treatment Failure Treatment Outcome |
| title | Predictors of treatment outcome in prosthetic joint infections treated with prosthesis retention |
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