Skip Navigation


JAC Advance Access originally published online on March 31, 2009
Journal of Antimicrobial Chemotherapy 2009 63(6):1264-1271; doi:10.1093/jac/dkp107
This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrowOA All Versions of this Article:
63/6/1264    most recent
dkp107v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Byren, I.
Right arrow Articles by Berendt, A.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Byren, I.
Right arrow Articles by Berendt, A.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Original research

One hundred and twelve infected arthroplasties treated with ‘DAIR’ (debridement, antibiotics and implant retention): antibiotic duration and outcome

I. Byren1,2,*,{dagger}, P. Bejon1,2,{dagger}, B. L. Atkins1,2,3, B. Angus2, S. Masters1, P. McLardy-Smith1, R. Gundle1 and A. Berendt1

1 Bone Infection Unit, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK 2 Nuffield Department of Medicine, Oxford University, John Radcliffe Hospital, Headley Way, Headington OX3 9DU, UK 3 Department of Microbiology, John Radcliffe Hospital, Headley Way, Headington OX3 9DU, UK

Received 23 January 2009; returned 16 February 2009; revised 25 February 2009; accepted 28 February 2009

* Corresponding author. Bone Infection Unit, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK. Tel: +44-1865-741841; Fax: +44-1865-738027; E-mail: ivor.byren{at}orh.nhs.uk

Objectives: We describe treatment failure rates by antibiotic duration for prosthetic joint infection (PJI) managed with debridement, antibiotics and implant retention (DAIR).

Methods: We retrospectively collected data from all the cases of PJI that were managed with DAIR over a 5 year period. Surgical debridement, microbiological sampling, early intravenous antibiotics and prolonged oral follow-on antibiotics were used.

Results: One hundred and twelve cases of PJI were identified. Twenty infections (18%) recurred during a mean follow-up of 2.3 years. The mean duration of antibiotic use was 1.5 years. Failure was more common after arthroscopic debridement, for previously revised joints and for Staphylococcus aureus infection. There were 12 failures after stopping antibiotics and 8 while on antibiotics [hazard ratio (HR) = 4.3, 95% confidence interval (CI) 1.4–12.8, P = 0.01]. However, during the first 3 months of follow-up, there were eight failures after stopping antibiotics and two while on antibiotics (HR = 7.0, 95% CI 1.5–33, P = 0.015). The duration of antibiotic therapy prior to stopping did not predict outcome.

Conclusions: PJI may be managed by DAIR. The risk of failure with this strategy rises after stopping oral antibiotics, but lengthening antibiotic therapy may simply postpone, rather than prevent, failure.

Keywords: prosthetic , infection , management

{dagger} These authors contributed equally to this work.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.