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Shah NB, Hersh BL, Kreger A, Sayeed A, Bullock AG, Rothenberger SD, Klatt B, Hamlin B, Urish KL. Reply to Courjon and Del Giudice. Clin Infect Dis 2021; 72:177-178. [PMID: 32518947 DOI: 10.1093/cid/ciaa392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Neel B Shah
- Division of Infectious Disease, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Beverly L Hersh
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alex Kreger
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Aatif Sayeed
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Andrew G Bullock
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Scott D Rothenberger
- Center for Research on Health Care Data Center, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brian Klatt
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brian Hamlin
- The Bone and Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kenneth L Urish
- Arthritis and Arthroplasty Design Group, the Bone and Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
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Shah NB, Hersh BL, Kreger A, Sayeed A, Bullock AG, Rothenberger SD, Klatt B, Hamlin B, Urish KL. Benefits and Adverse Events Associated With Extended Antibiotic Use in Total Knee Arthroplasty Periprosthetic Joint Infection. Clin Infect Dis 2021; 70:559-565. [PMID: 30944931 DOI: 10.1093/cid/ciz261] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/26/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) periprosthetic joint infection (PJI) can be managed with debridement, antibiotic therapy, and implant retention (DAIR). Oral antibiotics can be used after DAIR for an extended time period to improve outcomes. The objective of this study was to compare DAIR failure rates and adverse events between an initial course of intravenous antibiotic therapy and the addition of extended treatment with oral antibiotics. METHODS A multicenter observational study of patients diagnosed with a TKA PJI who underwent DAIR was performed. The primary outcome of interest was the failure rate derived from the survival time between the DAIR procedure and future treatment failure. RESULTS One hundred eight patients met inclusion criteria; 47% (n = 51) received an extended course of oral antibiotics. These patients had a statistically significant lower failure rate compared to those who received only intravenous antibiotics (hazard ratio, 2.47; P = .009). Multivariable analysis demonstrated that extended antibiotics independently predicted treatment success, controlling for other variables. There was no significant difference in failure rates between an extended course of oral antibiotics less or more than 12 months (P = .23). No significant difference in the rates of adverse events was observed between patients who received an initial course of antibiotics alone and those who received a combination of initial and extended antibiotic therapy (P = .59). CONCLUSIONS Extending therapy with oral antibiotics had superior infection-free survival for TKA PJI managed with DAIR. There was no increase in adverse events, demonstrating safety. After 1 year, there appears to be no significant benefit associated with continued antibiotic therapy.
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Affiliation(s)
- Neel B Shah
- Division of Infectious Disease, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Beverly L Hersh
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alex Kreger
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aatif Sayeed
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew G Bullock
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Scott D Rothenberger
- Center for Research on Health Care Data Center, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Brian Klatt
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Brian Hamlin
- Bone and Joint Center, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kenneth L Urish
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.,Arthritis and Arthroplasty Design Group, Bone and Joint Center, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Bioengineering, and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania
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Shah NB, Hersh BL, Kreger A, Sayeed A, Bullock AG, Rothenberger SD, Klatt B, Hamlin B, Urish KL. Reply to Wouthuyzen-Bakker et al. Clin Infect Dis 2020; 70:1260-1261. [PMID: 31292620 PMCID: PMC7931842 DOI: 10.1093/cid/ciz632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Neel B Shah
- Division of Infectious Disease, Department of Internal Medicine, University of Pittsburgh Medical Center, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Beverly L Hersh
- University of Pittsburgh School of Medicine, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Alex Kreger
- University of Pittsburgh School of Medicine, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Aatif Sayeed
- University of Pittsburgh School of Medicine, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Andrew G Bullock
- University of Pittsburgh School of Medicine, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Scott D Rothenberger
- Center for Research on Health Care Data Center, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Brian Klatt
- Department of Orthopaedic Surgery, University of Pittsburgh, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Brian Hamlin
- Bone and Joint Center, and, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Kenneth L Urish
- Arthritis and Arthroplasty Design Group, Bone and Joint Center, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Carnegie Mellon University, Pittsburgh, Pennsylvania
- Department of Orthopaedic Surgery, Department of Bioengineering, Carnegie Mellon University, Pittsburgh, Pennsylvania and Clinical and Translational Science Institute, University of Pittsburgh
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania
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Urish KL, Bullock AG, Kreger A, Shah NB, Jeong K, Rothenberger SD. A Multicenter Study of Irrigation and Debridement in Total Knee Arthroplasty Periprosthetic Joint Infection: Treatment Failure Is High. J Arthroplasty 2018; 33:1154-1159. [PMID: 29221840 PMCID: PMC5858958 DOI: 10.1016/j.arth.2017.11.029] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In total knee arthroplasty (TKA) periprosthetic joint infection (PJI), irrigation and debridement (I&D) with component retention is a treatment option with a wide variation in reported failure rates. The purpose of this study was to determine failure rates, outcomes, and factors that predict failure in I&D for TKA PJI. METHODS A multicenter observational study of patients with a TKA PJI and subsequently undergoing an I&D with retention of components was conducted. The primary outcome was failure rate of I&D, where failure was defined as any subsequent surgical procedures. RESULTS Two hundred sixteen cases of I&D with retention of components performed on 206 patients met inclusion criteria. The estimated long-term failure rate at 4 years was 57.4%. Time-to-event analyses revealed that the median survival time was 14.32 months. Five-year mortality was 19.9%. Multivariable modeling revealed that time symptomatic and organism were independent predictors of I&D failure. Culture-negative status had a higher hazard for failure than culture-positive patients. When primary organism and time symptomatic were selected to produce an optimized scenario for an I&D, the estimated failure rate was 39.6%. CONCLUSION I&D with retention of components has a high failure rate, and there is a high incidence of more complex procedures after this option is chosen. The patient comorbidities we investigated did not predict I&D success. Our results suggest that I&D has a limited ability to control infection in TKA and should be used selectively under optimum conditions.
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Affiliation(s)
- Kenneth L. Urish
- Arthritis and Arthroplasty Design Group, The Bone and Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center; Department of Orthopaedic Surgery, Department of Bioengineering, and Clinical and Translational Science Institute, University of Pittsburgh; Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, 15219
| | | | - Alex Kreger
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15261
| | - Neel B. Shah
- Division of Infectious Disease, Department of Internal Medicine; University of Pittsburgh Medical Center, Pittsburgh, PA 15219
| | - Kwonho Jeong
- Clinical and Translation Science Institute; Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213
| | - Scott D. Rothenberger
- Clinical and Translation Science Institute; Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213
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