title: Irrigation and debridement for periprosthetic infections: does the organism matter?
abstract: Irrigation and debridement (I&D) is an attractive treatment alternative for periprosthetic joint infection (PJI). Irrigation and debridement failure rates average 64% (range, 10.5%-84%) and may be associated with causative organism type and virulence. The study objective was to compare revision rates for PJI caused by streptococcal organisms to other organisms treated with I&D. A multicenter retrospective cohort study of 200 consecutive PJIs treated with I&D was performed. Failure was defined as reoperation for PJI. Failure rate for streptococcal infections was 65% (20/31) compared with 71% (84/119) for other organisms. Failure rate for sensitive Staphylococcus was 72% (48/67) compared with a 76% (22/29) failure rate for resistant Staphylococcus. These results indicate that eradication rates of I&D for a streptococcal PJI are comparable with other causative organisms. Irrigation and debridement should play a limited role in the PJI treatment algorithm regardless of organism type.
authors.affiliation: OrthoCarolina Research Institute, Inc, Charlotte, North Carolina 28207, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Odum
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Fehring
authors.forename: Adolph V
authors.initials: AV
authors.lastname: Lombardi
authors.forename: Ben M
authors.initials: BM
authors.lastname: Zmistowski
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Brown
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Luna
authors.forename: Keith A
authors.initials: KA
authors.lastname: Fehring
authors.forename: Erik N
authors.initials: EN
authors.lastname: Hansen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000818:Animals; D015331:Cohort Studies; D003646:Debridement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000382:microbiology*; D006801:Humans; D007720:Knee Prosthesis / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000628:therapy*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000628:therapy; D013210:Staphylococcus / Q000302:isolation & purification*; D013290:Streptococcal Infections / Q000628:therapy; D013291:Streptococcus / Q000302:isolation & purification*; D007507:Therapeutic Irrigation / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult