What factors are associated with the successful treatment of acute periprosthetic joint infection (PJI) using debridement, antibiotics and implant retention (DAIR)?

Authors: Marjan Wouthuyzen-Bakker, Alex Soriano
RECOMMENDATION: The following factors have been shown to be associated with treatment success in acute PJIs treated with DAIR:
• Exchanging the modular components during debridement
• Performing a debridement within at least seven days, but preferably as soon as possible, after the onset of symptoms
• Adding rifampin to the antibiotic regimen, particularly when combined with a fl uoroquinolone, in cases of susceptible staphylococci
• Treatment with fl uoroquinolones in cases of susceptible gram-negative bacilli
The following factors have been shown to be associated with treatment failure in acute PJIs treated with DAIR:
• Host related factors: rheumatoid arthritis, old age, male sex, chronic renal failure, liver cirrhosis and chronic obstructive pulmonary disease
• Prosthesis indication: fracture as indication for the prosthesis, cemented prostheses and revised prostheses
• Clinical presentation representing the severity of the infection: a high C-reactive protein (CRP), a high bacterial inoculum and the presence of bacteremia
• Causative microorganisms: S. aureus and Enterococcoci
LEVEL OF EVIDENCE: Moderate
DELEGATE VOTE: Agree: 92%, Disagree: 5%, Abstain: 3% (Super Majority, Strong Consensus)

hk98