title: Increased risk of joint failure in hip prostheses infected with Staphylococcus aureus treated with debridement, antibiotics and implant retention compared to Streptococcus.
abstract: OBJECTIVE
  The debridement, antibiotic and implant retention (DAIR) procedure is an option for patients with prosthetic hip joint infections for whom arthroplasty removal is problematic. Unfortunately, some of the guidelines proposed for deciding on DAIR management of arthroplasty infections fail to take into consideration the role of the infecting pathogen. While Staphylococcus aureus and streptococci are major contributors to infected hip arthroplasties, their respective contributions to treatment success or failure rates with the DAIR procedure have not been thoroughly analysed from a microbiological perspective.
  
  
  METHODS
  This retrospective study included all patients who were hospitalised in Geneva University Hospitals between 1996 and 2012 and were initially treated with DAIR for prosthetic hip joint monomicrobial infection due to S. aureus or Streptococcus spp. The outcome of DAIR treatment was evaluated after a minimal follow-up of two years. A literature search was also performed to retrieve data from additional DAIR-treated cases in other institutions.
  
  
  RESULTS
  In our institution, 38 DAIR-treated patients with hip arthroplasty monomicrobial infections underwent at least one surgical debridement (median two, range one to five), exchange of mobile parts and concomitant targeted antibiotic therapy for several weeks or months. A literature search identified outcome data in other institutions from 52 additional DAIR-treated cases according to our study criteria. After merging our own data with those retrieved from other reports, we found a failure rate of 21 % instead of 24 % for S. aureus-infected, DAIR-treated patients, but no failure in 14 streptococcal-infected patients. In the pooled data, the failure rate linked with S. aureus infections was significantly higher than that with Streptococcus ssp. (19/90 vs 0/14 episodes; Fisher's exact test, P = 0.07).
  
  
  CONCLUSIONS
  DAIR-treated patients with prosthetic hip joint infections due to S. aureus tended to have worse outcomes than those infected with Streptococcus spp. The specific influence of the infecting pathogen should be considered in future guidelines and recommendations.
authors.affiliation: Orthopedic Surgery Service, Geneva University Hospitals & Medical School, University of Geneva, Geneva, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Betz
authors.forename: Sophie
authors.initials: S
authors.lastname: Abrassart
authors.forename: Pierre
authors.initials: P
authors.lastname: Vaudaux
authors.forename: Ergys
authors.initials: E
authors.lastname: Gjika
authors.forename: Maximilian
authors.initials: M
authors.lastname: Schindler
authors.forename: Julien
authors.initials: J
authors.lastname: Billières
authors.forename: Besa
authors.initials: B
authors.lastname: Zenelaj
authors.forename: Domizio
authors.initials: D
authors.lastname: Suvà
authors.forename: Robin
authors.initials: R
authors.lastname: Peter
authors.forename: Ilker
authors.initials: I
authors.lastname: Uçkay
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement / Q000379:methods; D020878:Device Removal; D019544:Equipment Failure Analysis; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000150:complications* / Q000382:microbiology / Q000628:therapy*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy; D013290:Streptococcal Infections / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents