Journal Article

Treatment of Joint Prosthesis Infection in Accordance with Current Recommendations Improves Outcome

Belinda Y. Betsch, Stefan Eggli, Klaus A. Siebenrock, Martin G. Täuber and Kathrin Mühlemann

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 46, issue 8, pages 1221-1226
Published in print April 2008 | ISSN: 1058-4838
Published online April 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/529436
Treatment of Joint Prosthesis Infection in Accordance with Current Recommendations Improves Outcome

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Background. Recently recommended treatment modalities for prosthetic joint infection (PJI) were evaluated.

Methods. A retrospective cohort analysis of 68 patients with PJI of hip or knee who were treated from 1995 through 2004 was conducted at the University Hospital Bern (Bern, Switzerland).

Results. A 2-stage exchange was the most frequent (75.0%) surgical strategy, followed by retention and/or debridement (17.6%), 1-stage exchange (5.9%), and resection arthroplasty or suppressive antimicrobial treatment (1.5%). The chosen strategy was in 88% agreement with the recommendations. Adherence was only 17% for retention and/or debridement and was 0% for 1-stage exchange. Most PJIs (84%) were treated with an adequate or partially adequate antimicrobial regimen. Recurrence-free survival was observed in 51.5% of PJI episodes after 24 months of follow-up. The risk of treatment failure was significantly higher for PJI treated with a surgical strategy other than that recommended (hazard ratio, 2.34; 95% confidence interval, 1.10–4.70; P=.01) and for PJIs treated with antibiotics not corresponding to recommendations (hazard ratio, 3.45; confidence interval, 1.50–7.60; P=.002). Other risk factors associated with lack of healing were a high infection score at the time of diagnosis (hazard ratio, 1.29; 95% confidence interval, 1.10–1.40; P<.001) and presence of a sinus tract (hazard ratio, 2.35; 95% confidence interval, 1.10–5.0; P=.02).

Conclusions. Our study demonstrates the value of current treatment recommendations. Inappropriate choice of conservative surgical strategies (such as debridement and retention) and inadequate antibiotic treatment are associated with failure.

Journal Article.  2567 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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