title: Treatment of joint prosthesis infection in accordance with current recommendations improves outcome.
abstract: 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 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 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.
authors.affiliation: Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland.
authors.forename: Belinda Y
authors.initials: BY
authors.lastname: Betsch
authors.forename: Stefan
authors.initials: S
authors.lastname: Eggli
authors.forename: Klaus A
authors.initials: KA
authors.lastname: Siebenrock
authors.forename: Martin G
authors.initials: MG
authors.lastname: Täuber
authors.forename: Kathrin
authors.initials: K
authors.lastname: Mühlemann
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D019643:Arthroplasty, Replacement / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006622:Hip Prosthesis / Q000382:microbiology; D006801:Humans; D007595:Joint Prosthesis / Q000382:microbiology*; D007720:Knee Prosthesis / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents