Outcome of prosthetic joint infections treated with debridement and retention of components

被引:343
作者
Marculescu, CE
Berbari, EF
Hanssen, AD
Steckelberg, JM
Harmsen, SW
Mandrekar, JN
Osmon, DR
机构
[1] Mayo Clin Coll Med, Dept Internal Med, Div Infect Dis, Rochester, MN 55905 USA
[2] Mayo Clin Coll Med, Dept Orthoped, Rochester, MN 55905 USA
[3] Mayo Clin Coll Med, Dept Biostat, Rochester, MN 55905 USA
[4] Med Univ S Carolina, Div Infect Dis, Charleston, SC 29425 USA
关键词
D O I
10.1086/499234
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Debridement and retention of the prosthesis represents an attractive surgical modality for treatment of prosthetic joint infection, but risk factors for treatment failure require clarification. Methods. We conducted a retrospective cohort analysis of all patients with a prosthetic joint infection who were treated with debridement and retention of the prosthesis at the Mayo Clinic ( Rochester, Minnesota) between 1995 and 1999. Results. Debridement and retention of the prosthesis was the initial treatment modality for 99 episodes of prosthetic joint infection that occurred in 91 patients who presented to the Mayo Clinic during 1995 - 1999. A total of 32% and 23% of all episodes were due to Staphylococcus aureus and coagulase-negative staphylococci, respectively. The median duration of intravenous antimicrobial therapy was 28 days ( range, 1 - 90 days). Oral antimicrobial suppression was used in 89% of the episodes, for a median duration of 541 days ( range, 5 - 2673 days). Treatment failure occurred in 53 episodes during a median follow-up period of 700 days ( range, 1 - 2779 days). The 2-year survival rate free of treatment failure was 60% (95% confidence interval [CI], 50% - 71%). Variables associated with an increased risk of treatment failure in multivariable analysis included the presence of a sinus tract (hazard ratio, 2.84; 95% CI, 1.48 - 5.44; P = .002) and a duration of symptoms prior to debridement of >= 8 days (hazard ratio, 1.77; 95% CI, 1.02 - 3.07; P = .04). Conclusions. Debridement and retention of the prosthesis is a common surgical modality at our institution to treat prosthetic joint infection. Risk factors independently associated with treatment failure include the presence of a sinus tract and duration of symptoms prior to debridement of >= 8 days.
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页码:471 / 478
页数:8
相关论文
共 39 条
[1]   THE AMERICAN-RHEUMATISM-ASSOCIATION 1987 REVISED CRITERIA FOR THE CLASSIFICATION OF RHEUMATOID-ARTHRITIS [J].
ARNETT, FC ;
EDWORTHY, SM ;
BLOCH, DA ;
MCSHANE, DJ ;
FRIES, JF ;
COOPER, NS ;
HEALEY, LA ;
KAPLAN, SR ;
LIANG, MH ;
LUTHRA, HS ;
MEDSGER, TA ;
MITCHELL, DM ;
NEUSTADT, DH ;
PINALS, RS ;
SCHALLER, JG ;
SHARP, JT ;
WILDER, RL ;
HUNDER, GG .
ARTHRITIS AND RHEUMATISM, 1988, 31 (03) :315-324
[2]   Risk factors for prosthetic joint infection: Case-control study [J].
Berbari, EF ;
Hanssen, AD ;
Duffy, MC ;
Steckelberg, JM ;
Ilstrup, DM ;
Harmsen, WS ;
Osmon, DR .
CLINICAL INFECTIOUS DISEASES, 1998, 27 (05) :1247-1254
[3]  
Borden L S, 1987, J Arthroplasty, V2, P27, DOI 10.1016/S0883-5403(87)80028-1
[4]   Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention [J].
Brandt, CM ;
Sistrunk, WW ;
Duffy, MC ;
Hanssen, AD ;
Steckelberg, JM ;
Ilstrup, DM ;
Osmon, DR .
CLINICAL INFECTIOUS DISEASES, 1997, 24 (05) :914-919
[5]  
BRAUSE BD, 1982, ORTHOP CLIN N AM, V13, P245
[6]  
BURGER RR, 1991, CLIN ORTHOP RELAT R, P105
[7]   SUSCEPTIBILITY OF STAPHYLOCOCCUS-AUREUS GROWING ON FIBRONECTIN-COATED SURFACES TO BACTERICIDAL ANTIBIOTICS [J].
CHUARD, C ;
VAUDAUX, P ;
WALDVOGEL, FA ;
LEW, DP .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 1993, 37 (04) :625-632
[8]  
CHUARD C, 1991, J INFECT DIS, V163, P1369
[9]   SUCCESSFUL THERAPY OF EXPERIMENTAL CHRONIC FOREIGN-BODY INFECTION DUE TO METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS BY ANTIMICROBIAL COMBINATIONS [J].
CHUARD, C ;
HERRMANN, M ;
VAUDAUX, P ;
WALDVOGEL, FA ;
LEW, DP .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 1991, 35 (12) :2611-2616
[10]  
COLLINS DN, 1991, CLIN ORTHOP RELAT R, V269, P9