809. Debridement, Antibiotics and Implant Retention: Postulating Optimal Antimicrobial Duration
Session: Poster Abstract Session: Bone and Joint
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background:

Debridement, antibiotics and implant retention (DAIR) is a widely practiced treatment approach for the management of prosthetic joint infection (PJI). We describe the local experience with DAIR at two New Zealand hospitals and postulate the optimal antimicrobial treatment duration.

Methods:

We retrospectively reviewed all total joint arthroplasty PJIs managed with DAIR between 2006 and 2010 at our two hospitals.

Results:

We identified 134 episodes of PJI managed with DAIR in 115 patients. One third of episodes (34%) had a history of previous joint revision. Three quarters (74%) presented within 7 days of symptom onset. A sinus tract or unstable joint was present in 16%. The median duration of antimicrobial therapy was 61 days. Rifampicin was administered in 31 (23%) episodes. Forty seven (37%) episodes involved infection with Staphylococcus aureus. The overall success rate was 56%. Univariate risk factors for failure were; previous PJI, sinus tract or unstable prosthesis, symptom duration to presentation > 7 days and a shorter total duration of antimicrobials. The univariate association with shorter total antimicrobial duration first becomes statistically significant at < 91 days (p = 0.0318). A Kaplan-Meier plot for failure free survival following cessation of antimicrobials showed an initial period of high risk for failure (47% failure in the first 30 days) however subsequent failure free probability mirrored the failure free probability for the entire cohort.

Conclusion:

Our study has shown outcomes consistent with other published retrospective cohorts managed with DAIR. Our study adds evidence supporting a minimum 3 month total duration of antimicrobials following DAIR surgery. It also adds further evidence that prolonged antimicrobial therapy is likely to delay failure rather than improve cure.

Christopher Luey1, Stephen Mcbride1 and Simon Briggs2, (1)Middlemore Hospital, Auckland, New Zealand, (2)Auckland City Hospital, Auckland, New Zealand

Disclosures:

C. Luey, None

S. Mcbride, None

S. Briggs, None

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