1139. Prosthetic Joint Infection: A Single Center Study Comparing DAIR (Debridement, Antibiotics, Irrigation, and Retention) vs. Exchange Arthroplasty
Session: Poster Abstract Session: Clinical Infectious Diseases: Bone and Joint, Skin and Soft Tissue
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Salgueiro - ID Week PJI.pdf (422.4 kB)
  • Background: Approximately 600,000 primary arthroplasties are performed in the United States annually, of which 2.5% are complicated by prosthetic joint infections (PJI). PJIs are largely treated by a debridement and retention (DAIR) strategy or by a 1 or 2 stage exchange arthroplasty (EA).

    Study aims include: 1) identify strategy specific risk factors associated with treatment failure 2) assess outcomes when 2 stage exchange is performed as primary strategy vs. following a failed DAIR strategy.

    Methods: We performed a restrospective review of patients admitted to the Beth Israel Deaconess Medical Center (BIDMC) between 7/1/04-7/1/15 with PJI. Data regarding reasons for implant, PJI presentation and management were collected. Treatment failure was defined as one of the following occurring within 1 year from treatment: re-intervention in the same joint, death related to PJI, or physician diagnosis of recurrence.

    Results: 84 patients have been fully characterized to date. 65 (77%) underwent DAIR, 15 (18%) exchange arthroplasty (EA) and 4 (5%) girdlestone as their first procedure. Comparing patients treated by DAIR strategy vs. EA, patients undergoing EA were more likely to have a duration of symptoms > 3 weeks 9 (60%) vs. 13 (20%) p=0.003 and to have hardware loosening 6 (40%) vs. 5 (8%) p=0.004. Streptococcal sp. were the most common cause of infection in both groups (16 [24%] DAIR, 5 [33%] EA), followed by coagulase-negative Staphylococcus(11 [17%] vs. 4 [27%]), MSSA (10 [16%] vs. 2 [13%]) and MRSA (6 [9%] vs. 1 [7%]). Of patients with Staphylococcal sp. treated by DAIR, 17 (63%) received rifampin. Antibiotic associated adverse events occurred in 28 (29%) of patients. 24 (37%) of patients undergoing DAIR sustained treatment failure vs. 8 (53%) in the EA group (p=0.38). 20 patients who failed initial DAIR underwent subsequent EA with 12 failures (60%) observed with no significant difference compared to initial EA (53%) p=0.74.

    Conclusion: We have observed an elevated rate of treatment failures in both the DAIR and EA groups. No significant difference in outcome was seen in patients undergoing EA following failed DAIR vs. EA as an initial approach. Our failure rates with EA after DAIR are however greater than those typically noted in published series of primary EA for PJI.

    Francisco Salgueiro, MD, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, Mary Lasalvia, MD, MPH, Medicine, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, Christopher Rowley, MD/MPH, Beth Israel Deaconess Medical Center, Boston, MA and Adolf Karchmer, MD, FIDSA, Division of Infectious Diseaes, Beth Israel Deaconess Medical Center, Boston, MA

    Disclosures:

    F. Salgueiro, None

    M. Lasalvia, None

    C. Rowley, None

    A. Karchmer, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.