1545. Management Challenges of Prosthetic Joint Infections at Sunnybrook Health Sciences Centre
Session: Poster Abstract Session: Clinical Infectious Diseases: Prosthetic Joint Infections
Saturday, October 10, 2015
Room: Poster Hall
Background: Prosthetic joint infections (PJI) are becoming more common, however there is a lack of high-grade evidence to guide therapy of these complex infections. We sought to assess current practice heterogeneity at Sunnybrook Health Sciences Centre (SHSC) and Holland Orthopedic and Arthritic Centre (HOAC) and assess surgical and antibiotic strategies associated with clinical outcomes.

Methods: We retrospectively reviewed patients with PJI who had revision surgery between January 1, 2000 and December 31, 2010 at SHSC/ HOAC. PJI were identified using the Ontario Joint Replacement Record System. Infection was defined by gross intraoperative evidence, positive intraoperative culture, and/or sinus tract prior to operation. The primary outcome was treatment failure at one year after revision surgery based on further surgery, ongoing infection and/or continuous suppressive antibiotics.

Results: Of the 139 patients with PJI, 85 (61%) involved knees and 50 (36%) hips. For the initial procedure, 29 (21%) underwent I&D, 35 (25%) one-stage, and 75 (54%) two-stage revisions. Of 81 (58%) culture positive cases, CNST (47;34%) and Staph. aureus (18;13%) were the most common pathogens The overall treatment success rate was 78% (95% CI: 70-84). There was no difference in outcome between one-stage (94%; 95% CI: 81-98) and two-stage revisions (84%; 95% CI: 74-91). Only 41% (95%; CI: 26-59) of I&D procedures were successful.  Multivariate logistic regression analysis revealed I&D associated with high failure rates (odds ratio = 102.4; 95% CI: 8.6-1225.3), with a trend towards lower failure rates with one versus two-stage revision (odds ratio = 0.028, 95% CI: 0.001-1.500). Other predictors of treatment failure included history of prior revisions, and infection with Peptostreptococcus spp. Among two-stage revisions, we did not detect a significant reduction in treatment failure associated with antibiotic-free period prior to the second procedure (OR 2.6, 95%CI 0.23-29.8).

Conclusion: Our findings question the value of customary approaches to prosthetic joint infection management such as the use of two stage procedures and antibiotic-free periods prior to definitive revision. Randomized controlled trials are needed to inform best practice for treatment of these complex infections.

Lucas Castellani, MBBS, University of Toronto, Toronto, ON, Canada, Nick Daneman, MD, MSc, Division of Infectious Diseases & Clinical Epidemiology, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada, Samira Mubareka, MD, Department of Medical Microbiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada and Richard Jenkinson, MD, Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

Disclosures:

L. Castellani, None

N. Daneman, None

S. Mubareka, None

R. Jenkinson, None

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