![]() (I) growth of the same microorganism in at least 2 culture specimens (preoperative joint aspiration and/or intraoperative, intracapsular specimen) (II) 1 positive culture, and intracapsular purulence during debridement procedure, acute inflammation on histopathological examination of intraoperative specimen, and/or an actively draining sinus tract (III) culture-negative infection: negative culture results and at least 2 of intracapsular purulence during debridement procedure, acute inflammation on histopathological examination of intraoperative specimen, and an actively draining sinus tract. (1998), and required 1 or more of the following criteria: Prosthetic joint-associated infection was defined according to Crockarell et al. This was a retrospective cohort study, with a follow-up of at least 2 years or until the patient died. We evaluated the outcome of DAIR for total hip and knee PJI in 3 Dutch hospitals, to study factors associated with successful outcome and to study the outcomes of the use of local antibiotic carriers. These can also act as foreign bodies, to which bacteria might adhere ( Barth et al. Beads have a prolonged release compared to sponges but do not reach such high concentrations ( Diefenbeck et al. Local antibiotic treatment, with aminoglycosides in beads or sponges, could theoretically reach high local concentrations without exposing the patient to toxic serum levels. Implant removal leaves the patient disabled for weeks or even months ( Osmon et al. In the case of chronic infections, implant retention is rarely successful. Success can be achieved in over 70% of the cases when patients with favorable factors are selected, such as those with short duration of symptoms (less than 3–4 weeks), a stable implant, and healthy soft tissues surrounding the prosthesis ( Soriano et al. 1998) and as high as 100% ( Zimmerli et al. DAIR has shown varying success rates: as low as 14% ( Crockarell et al. 2013).Ī regimen of debridement, antibiotics, irrigation, and retention of the prosthesis (DAIR) is generally accepted for acute infections without complicating factors such as significant comorbidity or loosening of the prosthesis. A prevalence of 5–39% has been described for polymicrobial infections ( Moran et al. are less common causes, both at around 10% of the total, as are gram-negative bacteria such as Escherichia coli (< 5%) ( Moran et al. Most PJIs are caused by coagulase-negative Staphylococcus (30–41%) and S. 2013), and longer time between initial arthroplasty and PJI diagnosis ( Brandt et al. 2010), retention of exchangeable components ( Lora-Tamayo et al. ![]() 2013), intra-articular purulence ( Azzam et al. 2011), polymicrobial PJI ( Lora-Tamayo et al. 2010), and more specifically by Staphylococcus aureus ( Marculescu et al. Factors that have been associated with a worse outcome of PJI treatment include: infections caused by Staphylococcus spp. Revision surgery also increases the risk of PJI ( Bongartz et al. Various risk factors have been described that are associated with occurrence of PJI, such as rheumatoid arthritis, diabetes mellitus, malignancy, obesity, and use of immunosuppressant drugs ( Choong et al. A similar classification describes early (3 months), delayed/low-grade (3–24 months), and late infection (> 24 months) ( Trampuz and Zimmerli 2005). Generally, PJIs are classified in 3 groups, based on duration of symptoms and time after surgery: (I) early postoperative: symptoms less than 4 weeks after surgery (II) late chronic: a gradual, indolent onset of symptoms or (III) acute hematogenous: acute onset in a previously well-functioning prosthesis ( Tsukayama et al. Infected artificial joints are often unresponsive to antibiotic treatment, due to poor vascular supply and biofilm formation. Prosthetic joint-associated infection (PJI) occurs in around 1–2% of primary total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) ( Trampuz and Zimmerli 2005, Kurtz et al.
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