Debridement, Antibiotics and Implant Retention (DAIR) in Per
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The treatment of choice for acute postoperative and acute hematogenous Prosthetic Joint Infection (PJI) is debridement, antibiotics, and implant retention (DAIR). The goal of the study was to report on the results of DAIR and look into the predictive prognostic parameters.

Researchers retrospectively reviewed 106 DAIRs. Failure was defined as requiring removal of TKA implants. Predictive factors that may influence success of DAIR treatment such as age, gender, Body Mass Index, ethnicity, American Society of Anesthesiologists score, comorbidities, preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein, symptom duration, time between TKA and DAIR, cultures, Rifampicin use, polyethylene liner change and antibiotic duration were analyzed.

Results:
--The success rate of DAIR was 69.8% (74/106 patients). For successes, mean time from DAIR-to-mortality was longer than failures.

--Methicillin-susceptible Staphylococcus aureus (MSSA) PJI (OR 3.64) was a significant predictor for failure of DAIR.

--Higher pre-operative ESR correlated to failure (OR 1.02). In successes, mean ESR was 75.4 whereas mean ESR in failures was 116.

--An ESR more than 107.5 predicted failure with a sensitivity of 51.5, specificity of 85.2. ESR more than 107.5 correlated to failure (OR 6.60).

--Repeat DAIRs were strongly correlated to failure (OR 5.27)

In conclusion, DAIR failure is linked to a shorter time to death. Treatment failure is linked to repeated DAIRs, an elevated ESR of more than 107.5, and a Staphylococcus Aureus PJI, and two-stage revision is advised.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0883540321005052?dgcid=rss_sd_all
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