19 - ago. - 2019
The moment of implant-removal influences late acute periprosthetic joint infection
Currently the same therapeutic management is recommended in all acute infections of joint prostheses, both in late acute infection (patient with normal function of the prosthesis after 3 months of implantation and with onset of symptoms of <3 weeks duration) and in early acute infection (acute onset of symptoms <3 weeks in the first 3 months after implantation of the prosthesis). The treatment would consist of surgical debridement, antibiotic therapy and implant retention (DAIR). However, this therapeutic approach seems to be changing.
Researchers belonging to the group of Epidemiology and Pathogenic and Molecular Mechanisms of Infectious Diseases and Clinical Microbiology in collaboration with the European Study Group for Implant Associated Infections (ESGIAI) have recently demonstrated that implant failure is higher in cases of late acute infection treated with DAIR and implant retention, especially when the causative agent of the infection is S. aureus with failure rates that reach 50% (10.1016 / j.jinf.2018.07.014). Along the same lines, a retrospective multicenter study conducted by the same research group has just been published in the Journal of Infection (DOI: 10.1016 / j.jinf.2019.07.003) where they describe a preoperative risk score (CRIME80) for Identify patients at high risk of implant failure in the case of being treated with DAIR. The results of this study suggest a replacement of the joint prosthesis in those patients with a CRIME80-score ≥ 3, in infections caused by S. aureus in particular when the mobile component of the prosthesis has not been replaced and in those cases where It is possible to use an antibiotic regimen with rifampin.