We reviewed the electronic medical record of all patients that met our inclusion criteria. We excluded patients who were not managed with DAIR (eg, 1-stage or 2-stage exchange arthroplasty), underwent DAIR in another facility, did not consent to research, or died within the same admission. Patients who met the criteria for PJI and underwent DAIR for the first time in our institution were included. The TJR and PJI database collected information on all cases of PJI diagnosed in our institution regardless of where the index arthroplasty was performed. We queried our institution’s Total Joint Registry (TJR) and its accompanying PJI database for an initial list of patients. We performed a retrospective cohort study of patients 18 years and older diagnosed with PJI of the hip or knee and who underwent DAIR between Januand Decemat a quaternary academic medical center. More specifically, we assessed the effect of the duration of rifampin use by joint on risk of failure. For staphylococcal PJI, we also evaluated the risk of failure using rifampin and companion antibiotics. To that end, we evaluated the risk of failure of DAIR concerning the duration of IV and oral antibiotics. This study aimed to identify the optimal duration of antibiotics in DAIR. Observational studies also show conflicting results.
#Dair ortho trial#
An old randomized trial shows the superiority of rifampin with ciprofloxacin for staphylococcal PJI compared with ciprofloxacin alone, but a more recent trial did not show the same benefit. For the most common type of PJI, staphylococcal infections, the role of rifampin and its companion antibiotics is contested.
#Dair ortho full#
The ICM guidelines do not specify the route of antibiotics, whereas trials, including the Oral versus Intravenous Antibiotics for Bone and Joint Infection (OVIVA) trial, show that early transition to oral antibiotics is noninferior to a full course of IV antibiotics. The choice and route of antibiotics have garnered significant interest. Guidelines from the Infectious Diseases Society of America (IDSA) recommend a range of 2 to 6 weeks of initial IV antibiotics, whereas the International Consensus Meeting (ICM) guidelines on PJI suggest that 6 weeks is sufficient. Published studies show conflicting results, with some showing incremental benefit with indefinite chronic suppression whereas others support shorter durations of less than 1 year. Optimal regimens and duration of antimicrobial therapy in patients managed with DAIR are not fully elucidated. Patients are commonly managed with a course of intravenous (IV) antibiotic therapy to be followed by a prolonged oral regimen.
#Dair ortho skin#
The surgical procedure involves excision of infected skin margins and sinus tracts, if present, radical synovectomy, thorough lavage, and exchange of modular components such as a polyethylene liner. Debridement, antibiotics, and implant retention (DAIR) is one of the least invasive surgical management strategies for PJI. Despite advances in infection control and surgical technique, PJI still has significant morbidity and economic burden. It is unfortunate that periprosthetic joint infections (PJIs) complicate 0.5%–2% of primary THAs and TKAs. In the United States, primary total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) are projected to grow to more than 2 million procedures performed annually by 2030. Total joint arthroplasty is among the most commonly performed surgical procedures in the United States. Prosthetic joint infection, quinolone, rifampin, treatment duration
0 kommentar(er)
