title: Recurrent Periprosthetic Joint Infection After Irrigation and Debridement With Component Retention Is Most Often Due to Identical Organisms.
abstract: Irrigation and debridement with prosthetic retention (I&D) is an oft-utilized treatment option for PJI, despite its known limited success. While it is known that nearly half of all patients treated with I&D have recurrent infection, the organism persistence between infection events remains unreported. In addition, identifying those cases in which I&D routinely failed to eradicate the infection (not simply prevent recurrent infection) may allow improved patient selection for this less morbid procedure-a difficult task to date.
  
  
  
  Using an institutional database, 146 patients (153 joints) undergoing I&D between April 2000 and July 2013 were identified. There were 60 hips (40%). The overall success rate of I&D in this group was 52% (80/153). The failure group was limited to those patients with growth on culture at both initial failure and recurrent failure (46 cases). Analyses were performed to identify potential predictors of failed I&D and organism persistence in those cases.
  
  
  
  In the study group, 83.7% (36/43) of cases failed with the same organism. Knees with failed I&D had an organism persistence of 92.3% (24/26) compared with 70.5% (12/17; P = .09) for the hip. Patients initially infected with Staphylococcus aureus (specifically methicillin-resistant [13/13]) had a higher risk of persistent PJI (96%; 24/25) compared to other organisms (66.7%; 12/18; P = .01).
  
  
  
  I&D had a success rate of approximately 50% and typically failed due to organism persistence rather than a new infection. Given that persistent infection was most common in knees and S aureus, I&D should have a limited role in treating PJI, especially in these cases.
authors.affiliation: Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Zmistowski
authors.affiliation: Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Jorge
authors.initials: J
authors.lastname: Manrique
authors.affiliation: Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Ripal
authors.initials: R
authors.lastname: Patel
authors.affiliation: Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Antonia F
authors.initials: AF
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001170:Arthritis, Infectious / Q000382:microbiology* / Q000601:surgery; D003646:Debridement / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000382:microbiology* / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000601:surgery; D013211:Staphylococcus aureus; D017211:Treatment Failure
keywords: Staphylococcus aureus; complications; irrigation and debridement; organism persistence; periprosthetic joint infection