title: Debridement, antibiotics and implant retention in early periprosthetic joint infection.
abstract: BACKGROUND
  Periprosthetic joint infection (PJI) is a devastating complication in hip arthroplasty surgery. Debridement, antibiotics (AB) and implant retention (DAIR) is recommended in early PJI in association with stable implants. The aim of this study was to evaluate the success rate of DAIR in early PJI (&lt;4 weeks) and to identify factors predicting the outcome.
  
  
  METHODS
  This cohort study included a consecutive series of 35 patients (median age 74 years, 25 women, 26 primary arthroplasties) treated with DAIR for an early PJI in a regional hospital.
  
  
  RESULTS
  28 patients (80%) had their infection eradicated. DAIR-only eradicated the PJI in 22 (63%) patients with a median follow-up of 50 (24-84) months. In 17 (49%) patients, oral AB had been given prior to intraoperative cultures, which delayed first debridement with average 6 days and delayed hospital stay. Primary surgery for a hip fracture increased the risk of DAIR-failure. Surgical experience did not affect the outcome. 17% (n = 6) of the patients sustained a secondary infection during their hospital stay; the majority was beta-lactam resistant coagulase negative Staphylococcus aureus.
  
  
  CONCLUSIONS
  The success rate of DAIR was inferior to pervious controls from experienced revision centers. Hip fracture patients should be informed about the increased risk of DAIR treatment failure. In order not to delay surgery, empirically based oral AB should not be administered prior to deep cultures.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT02087020.
authors: Department of Orthopaedics at Danderyd Hospital and Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm - Sweden.
authors: Magnus
authors: M
authors: Bergkvist
authors: Department of Surgical and Perioperative Sciences, Umeå University, Umeå - Sweden.
authors: Sebastian S
authors: SS
authors: Mukka
authors: Department of Infectious Diseases, Karolinska University Hospital, Stockholm - Sweden.
authors: Lars
authors: L
authors: Johansson
authors: Department of Orthopaedics at Danderyd Hospital and Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm - Sweden.
authors: Torbjörn E
authors: TE
authors: Ahl
authors: Department of Surgical and Perioperative Sciences, Umeå University, Umeå - Sweden.
authors: Arkan S
authors: AS
authors: Sayed-Noor
authors: Department of Orthopaedics at Danderyd Hospital and Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm - Sweden.
authors: Olof G
authors: OG
authors: Sköldenberg
authors: Department of Orthopaedics at Danderyd Hospital and Karolinska Institute, Department of Clinical Sciences at Danderyd Hospital (KIDS), Stockholm - Sweden.
authors: Thomas
authors: T
authors: Eisler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D003646:Debridement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents