cfda9ab716be286b557b66736a84c3ba pmc_33530523.pdf 00bc079e1f5051b3e019147ecafb7d9448545180 pmc_33530523.pdf af00c72013e18ce5dd93e5960706668d56e590def22699769687cc0fa562e4da pmc_33530523.pdf Title: Implant Removal in the Management of Prosthetic Joint Infection by Staphylococcus aureus: Outcome and Predictors of Failure in a Large Retrospective Multicenter Study Subject: Objectives: To compare the characteristics and outcomes of cases with acute prosthetic joint infection (PJI; early post-surgical or hematogenous) by Staphylococcus aureus managed with implant removal (IRm) or debridement and retention (DAIR). To analyze the outcomes of all cases managed with IRm (initially or after DAIR failure). Methods: Retrospective, multicenter, cohort study of PJI by S. aureus (2003–2010). Overall failure included mortality within 60 days since surgery and local failure due to staphylococcal persistence/relapse. Results: 499 cases, 338 initially managed with DAIR, 161 with IRm. Mortality was higher in acute PJI managed initially with IRm compared to DAIR, but not associated with the surgical procedure, after propensity score matching. Underlying conditions, hemiarthroplasty, and methicillin-resistant S. aureus were risk factors for mortality. Finally, 249 cases underwent IRm (88 after DAIR failure); overall failure was 15.6%. Local failure (9.3%) was slightly higher in cases with several comorbidities, but independent of previous DAIR, type of IRm, and rifampin treatment. Conclusions: In a large multicenter study of S. aureus PJI managed with IRm, failure was low, but mortality significant, especially in cases with acute PJI and underlying conditions, but not associated with the IRm itself. Rifampin efficacy was limited in this setting. Keywords: Staphylococcus aureus; prosthetic joint infection; implant removal; outcome; rifampin Author: Joan Gómez-Junyent, Jaime Lora-Tamayo, Josu Baraia-Etxaburu, Mar Sánchez-Somolinos, Jose Antonio Iribarren, Dolors Rodriguez-Pardo, Julia Praena-Segovia, Luisa Sorlí, Alberto Bahamonde, Melchor Riera, Alicia Rico, Mª Dolores del Toro, Laura Morata, Javier Cobo, Luis Falgueras, Natividad Benito, Elena Muñez, Alfredo Jover-Sáenz, Carles Pigrau, Javier Ariza and Oscar Murillo Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Jan 26 14:12:42 2021 CET ModDate: Tue Jan 26 14:25:36 2021 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 654363 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- KORLVE+VnURWPalladioL Type 1 Custom yes yes no 10 0 QHFYVO+URWPalladioL-Ital Type 1 Custom yes yes no 15 0 UVDEYU+URWPalladioL-Bold Type 1 Custom yes yes no 20 0 ZDBELT+URWPalladioL-BoldItal Type 1 Custom yes yes no 24 0 AMNTHP+URWPalladioL-Roma Type 1 Custom yes yes no 28 0 PRJKGQ+VnURWPalladioL-Bold Type 1 Custom yes yes no 32 0 YYFPCJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 41 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 63 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 67 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 71 0 BHHCPL+Calibri CID TrueType Identity-H yes yes yes 95 0 BHHBCO+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 101 0 BHHBDA+PalatinoLinotype TrueType WinAnsi yes yes no 104 0 BHHBDC+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 107 0 BHHCAO+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 110 0 ZZLTBA+CMSY10 Type 1 Builtin yes yes no 117 0 BHHBCO+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 131 0 BHHBDA+PalatinoLinotype TrueType WinAnsi yes yes no 134 0 BHHBDC+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 137 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-05-27 02:49:24 CEST RepresentationInformation: pmc_33530523.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-03-31 12:08:44 CEST Size: 654363 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 306 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Children: Item: Title: Implant Removal as the Initial Surgical Strategy in the Cohort of Acute Prosthetic Joint Infection (PJI) Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Item: Title: Cohort of All Cases Managed with Implant Removal (Initially or Salvage Therapy) Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Children: Item: Title: Design, Setting, and Patients Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Definitions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Clinical and Surgical Management Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Outcomes and Follow-Up Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Item: Title: Statistical Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Info: Title: Implant Removal in the Management of Prosthetic Joint Infection by Staphylococcus aureus: Outcome and Predictors of Failure in a Large Retrospective Multicenter Study Author: Joan Gómez-Junyent, Jaime Lora-Tamayo, Josu Baraia-Etxaburu, Mar Sánchez-Somolinos, Jose Antonio Iribarren, Dolors Rodriguez-Pardo, Julia Praena-Segovia, Luisa Sorlí, Alberto Bahamonde, Melchor Riera, Alicia Rico, Mª Dolores del Toro, Laura Morata, Javier Cobo, Luis Falgueras, Natividad Benito, Elena Muñez, Alfredo Jover-Sáenz, Carles Pigrau, Javier Ariza and Oscar Murillo Subject: Objectives: To compare the characteristics and outcomes of cases with acute prosthetic joint infection (PJI; early post-surgical or hematogenous) by Staphylococcus aureus managed with implant removal (IRm) or debridement and retention (DAIR). To analyze the outcomes of all cases managed with IRm (initially or after DAIR failure). Methods: Retrospective, multicenter, cohort study of PJI by S. aureus (2003 2010). Overall failure included mortality within 60 days since surgery and local failure due to staphylococcal persistence/relapse. Results: 499 cases, 338 initially managed with DAIR, 161 with IRm. Mortality was higher in acute PJI managed initially with IRm compared to DAIR, but not associated with the surgical procedure, after propensity score matching. Underlying conditions, hemiarthroplasty, and methicillin-resistant S. aureus were risk factors for mortality. Finally, 249 cases underwent IRm (88 after DAIR failure); overall failure was 15.6%. Local failure (9.3%) was slightly higher in cases with several comorbidities, but independent of previous DAIR, type of IRm, and rifampin treatment. Conclusions: In a large multicenter study of S. aureus PJI managed with IRm, failure was low, but mortality significant, especially in cases with acute PJI and underlying conditions, but not associated with the IRm itself. Rifampin efficacy was limited in this setting. 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