晚期急性人工关节周围感染中植入物取出的时机：一项多中心观察性研究。

Timing of implant-removal in late acute periprosthetic joint infection: A multicenter observational study.

机构信息

Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.

Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France.

出版信息

J Infect. 2019 Sep;79(3):199-205. doi: 10.1016/j.jinf.2019.07.003. Epub 2019 Jul 15.

DOI:10.1016/j.jinf.2019.07.003

PMID:31319141

Abstract

OBJECTIVES

We evaluated the treatment outcome in late acute (LA) periprosthetic joint infections (PJI) treated with debridement and implant retention (DAIR) versus implant removal.

METHODS

In a large multicenter study, LA PJIs of the hip and knee were retrospectively evaluated. Failure was defined as: PJI related death, prosthesis removal or the need for suppressive antibiotic therapy. LA PJI was defined as acute symptoms <3 weeks in patients more than 3 months after the index surgery and with a history of normal joint function.

RESULTS

445 patients were included, comprising 340 cases treated with DAIR and 105 cases treated with implant removal (19% one-stage revision (n = 20), 74.3% two-stage revision (n = 78) and 6.7% definitive implant removal (n = 7). Overall failure in patients treated with DAIR was 45.0% (153/340) compared to 24.8% (26/105) for implant removal (p < 0.001). Difference in failure rate remained after 1:1 propensity-score matching. A preoperative CRIME80-score ≥3 (OR 2.9), PJI caused by S. aureus (OR 1.8) and implant retention (OR 3.1) were independent predictors for failure in the multivariate analysis.

CONCLUSION

DAIR is a viable surgical treatment for most patients with LA PJI, but implant removal should be considered in a subset of patients, especially in those with a CRIME80-score ≥3.

摘要

目的

我们评估了清创保留假体（DAIR）与假体取出治疗晚期急性（LA）人工关节周围感染（PJI）的治疗效果。

方法

在一项大型多中心研究中，回顾性评估了髋膝关节 LA PJI。失败定义为：与 PJI 相关的死亡、假体取出或需要进行抑制性抗生素治疗。LA PJI 定义为指数手术后 3 个月以上的患者出现急性症状<3 周，且关节功能正常。

结果

共纳入 445 例患者，其中 340 例接受 DAIR 治疗，105 例接受假体取出治疗（19%为一期翻修（n=20），74.3%为二期翻修（n=78），6.7%为确定性假体取出（n=7）。DAIR 治疗的患者总失败率为 45.0%（153/340），而假体取出的患者为 24.8%（26/105）（p<0.001）。1:1 倾向评分匹配后，差异仍然存在。多变量分析显示，术前 CRIME80 评分≥3（OR 2.9）、金黄色葡萄球菌引起的 PJI（OR 1.8）和假体保留（OR 3.1）是失败的独立预测因素。