title: KLIC-score for predicting early failure in prosthetic joint infections treated with debridement, implant retention and antibiotics.
abstract: Debridement, irrigation and antibiotic treatment form the current approach in early prosthetic joint infection (PJI). Our aim was to design a score to predict patients with a higher risk of failure. From 1999 to 2014 early PJIs were prospectively collected and retrospectively reviewed. The primary end-point was early failure defined as: 1) the need for unscheduled surgery, 2) death-related infection within the first 60 days after debridement or 3) the need for suppressive antibiotic treatment. A score was built-up according to the logistic regression coefficients of variables available before debridement. A total of 222 patients met the inclusion criteria. The most frequently isolated microorganisms were coagulase-negative staphylococci (95 cases, 42.8%) and Staphylococcus aureus (81 cases, 36.5%). Treatment of 52 (23.4%) cases failed. Independent predictors of failure were: chronic renal failure (OR 5.92, 95% CI 1.47-23.85), liver cirrhosis (OR 4.46, 95% CI 1.15-17.24), revision surgery (OR 4.34, 95% CI 1.34-14.04) or femoral neck fracture (OR 4.39, 95% CI1.16-16.62) compared with primary arthroplasty, C reactive protein >11.5 mg/dL (OR 12.308, 95% CI 4.56-33.19), cemented prosthesis (OR 8.71, 95% CI 1.95-38.97) and when all intraoperative cultures were positive (OR 6.30, 95% CI 1.84-21.53). A score for predicting the risk of failure was designed using preoperative factors (KLIC-score: Kidney, Liver, Index surgery, Cemented prosthesis and C-reactive protein value) and it ranged between 0 and 9.5 points. Patients with scores of ≤2, >2-3.5, 4-5, >5-6.5 and ≥7 had failure rates of 4.5%, 19.4%, 55%, 71.4% and 100%, respectively. The KLIC-score was highly predictive of early failure after debridement. In the future, it would be necessary to validate our score using cohorts from other institutions.
authors.affiliation: Department of Traumatology and Orthopaedic Surgery, Hospital Clinic of Barcelona, Spain. Electronic address: etornero@clinic.ub.es.
authors.forename: E
authors.initials: E
authors.lastname: Tornero
authors.affiliation: Service of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Morata
authors.affiliation: Department of Traumatology and Orthopaedic Surgery, Hospital Clinic of Barcelona, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: Martínez-Pastor
authors.affiliation: Department of Traumatology and Orthopaedic Surgery, Hospital Clinic of Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Bori
authors.affiliation: Department of Pharmacology, Hospital Clinic of Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Climent
authors.affiliation: Department of Traumatology and Orthopaedic Surgery, Hospital Clinic of Barcelona, Spain.
authors.forename: D M
authors.initials: DM
authors.lastname: García-Velez
authors.affiliation: Department of Traumatology and Orthopaedic Surgery, Hospital Clinic of Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: García-Ramiro
authors.affiliation: Service of Microbiology, Hospital Clinic of Barcelona, University of Barcelona, ISGlobal, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Bosch
authors.affiliation: Service of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Mensa
authors.affiliation: Service of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Soriano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001178:Arthroplasty / Q000009:adverse effects; D003646:Debridement; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy* / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000601:surgery*; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents
keywords: Debridement; failure; prosthetic joint infection; risk factors; score