title: Efficacy of debridement in hematogenous and early post-surgical prosthetic joint infections.
abstract: OBJECTIVE
  To review patients with a hematogenous and early post-surgical prosthetic joint infection (PJI) due to S. aureus treated with debridement and retention of the implant and to compare their clinical characteristics and outcome.
  
  
  METHODS
  From January 2000 all patients with a prosthetic joint infection treated in a single-center were prospectively registered and followed-up. All potentially variables associated with outcome were recorded. For the present study, cases with a hematogenous or early post-surgical PJI due to S. aureus treated with debridement and at least 2 years of follow-up were reviewed. Cox regression model to identify factors associated with outcome were applied.
  
  
  RESULTS
  12 hematogenous and 53 early post-surgical PJI due to S. aureus were included. Number of patients presenting with fever, leucocyte count, C-reactive protein concentration, and the number of bacteremic patients were significantly higher in hematogenous infections while the number of polymicrobial infections was lower in hematogenous than in early post-surgical infections. The global failure rate in hematogenous and early post-surgical PJI was 58.7% and 24.5%, respectively (p=0.02). The Cox regression model identified hematogenous infections (OR: 2.57, CI95%: 1.02-6.51, p=0.04) and the need of a second debridement (OR: 4.61, CI95%: 1.86-11.4, p=0.001) as independent predictors of failure.
  
  
  CONCLUSIONS
  Hematogenous infections were monomicrobial and had more severe symptoms and signs of infection than early post-surgical PJI. Hematogenous PJI due to S. aureus, using debridement with implant retention, had a worse outcome than early post-surgical infections.
authors.affiliation: Department of Orthopedics of Hospital Clínic of Barcelona, Hospital Clínic Universitari, IDIBAPS, Barcelona, Spain.
authors.forename: Félix
authors.initials: F
authors.lastname: Vilchez
authors.forename: Juan C
authors.initials: JC
authors.lastname: Martínez-Pastor
authors.forename: Sebastián
authors.initials: S
authors.lastname: García-Ramiro
authors.forename: Guillem
authors.initials: G
authors.lastname: Bori
authors.forename: Eduard
authors.initials: E
authors.lastname: Tornero
authors.forename: Esther
authors.initials: E
authors.lastname: García
authors.forename: Josep
authors.initials: J
authors.lastname: Mensa
authors.forename: Alex
authors.initials: A
authors.lastname: Soriano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000295:instrumentation; D016470:Bacteremia / Q000382:microbiology; D016009:Chi-Square Distribution; D003646:Debridement; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000601:surgery*; D012042:Registries; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D013203:Staphylococcal Infections / Q000097:blood / Q000382:microbiology / Q000601:surgery*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013997:Time Factors; D016896:Treatment Outcome