title: Treatment of prosthetic joint infections: validation of a surgical algorithm and proposal of a simplified alternative.
abstract: The Del Pozo and Patel (DPP) algorithm permits to identify suitable candidates for debridement and implant retention (DR) in prosthetic joint infections (PJI), but does not include gram-negative bacilli (GNB) as a risk factor of worst outcome. We conducted a retrospective study to validate the DPP algorithm and propose a simplified algorithm including GNB PJI. From 2002 to 2009, 73 PJI underwent surgery; 55% were chosen according to PDD algorithm. Non-adherence increased the risk of treatment failure (HR = 4.2). Performing DR in the presence of GNB PJI and performing DR in a joint prosthesis implanted for >3 months without hematogenous infection were independent risk factors. Our simplified algorithm, based on these 2 criteria, showed comparable performance to the DPP algorithm but increased eligibility for DR by a 2.4 fold.
authors.affiliation: Département de Microbiologie et Immunologie, Université de Montréal, Montréal, Canada.
authors.forename: Valérie
authors.initials: V
authors.lastname: Martel-Laferrière
authors.forename: Pierre
authors.initials: P
authors.lastname: Laflamme
authors.forename: Marc
authors.initials: M
authors.lastname: Ghannoum
authors.forename: Julio
authors.initials: J
authors.lastname: Fernandes
authors.forename: Daniela
authors.initials: D
authors.lastname: Di Iorio
authors.forename: Valéry
authors.initials: V
authors.lastname: Lavergne
mesh_terms: D000368:Aged; D000465:Algorithms; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015331:Cohort Studies; D003646:Debridement; D005260:Female; D019983:Guideline Adherence; D006622:Hip Prosthesis / Q000382:microbiology; D006801:Humans; D007720:Knee Prosthesis / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000628:therapy*; D012189:Retrospective Studies