![]() 7 There is evidence, in animal 8, 9 and human 10– 16 studies, that combinations of a fluoroquinolone and rifampicin are effective treatments in device-related staphylococcal infections. This makes the approach of debridement, antibiotics and implant retention (DAIR) attractive, especially in the elderly or infirm. Removal of a soundly fixed prosthesis with any bone cement may also result in degradation of the bone stock and peri-operative fracture. 6 Two-stage exchange, requiring two surgical procedures as a minimum, may present the patient and surgeon with significant attendant surgical and peri-operative risk including a substantial period of reduced mobility. Established PJI usually proves intractable to antibiotics alone, which led to the development of one- or two-stage surgical exchange revision protocols to achieve satisfactory outcomes. PJI complicates up to 2.5% 4 of the estimated 600 000 primary arthroplasties 5 performed annually in the USA. The microbiology MDT offers a robust way to facilitate antibiotic choice and delivery, and clinical correlation.Arthroplasty is one of the most cost-effective healthcare interventions described, 1– 3 but prosthetic joint infection (PJI) presents a major challenge to patients, physicians and funding agencies. Recommendation: Although small numbers, the DAIR procedure seems to work well to prevent patients with infected arthroplasty requiring a revision operation. 12 out of 14 patients are off antibiotics completely. 1 patient had a subsequent manipulation under anaesthetic for stiffness. 1 patient underwent subsequent revision arthroplasty. 1 patient required a repeat DAIR procedure, and 1 had a further debridement. 11 patients treated with a DAIR had no further open procedures. Oral antibiotic regimes after this were variable, with 6 patients having no oral antibiotics and the remainder receiving between 4 weeks and 2 having lifelong antibiotic suppression. 13 out of 14 patients received at least six weeks of IV antibiotics. Isolated organisms included 8 streptococcus species, 4 staphylococcus species, and 1 enterococcus species. Mean time from diagnosis to DAIR was 2.3 days (not including a single outlier of 8 days). Mean highest pre-DAIR CRP was 197 (60-347) to mean baseline post-DAIR CRP of 7.65 (0.5-18). All had open debridement, washout and exchange modular components, and 12 had antibiotic beads inserted. 5 were early infections, 3 delayed, and 6 late infections. Results: A total of 14 DAIR procedures were performed (8 TKRs, 4 THRs, 1 UKR and 1 revision TKR) as recorded by the microbiology MDT in the time period. An Excel spreadsheet was created and populated with data from iCM, PACS and patient notes. Method: A list of all patients undergoing DAIR from January 2017 to now was obtained from the microbiology MDT dynamic spreadsheet. This provided a system by which antibiotic regimens could be initiated and altered, outpatient antibiotics delivered, and clinical response to treatment assessed. A microbiology MDT was set up to facilitate the management of patients with bone and joint infections to include an infectious disease and OPAT consultant, OPAT pharmacist and orthopaedic consultant. Interventions include antibiotics, single-stage revision, two-stage revision, arthrodesis or amputation, or DAIR (debridement, antibiotics and implant retention). Introduction: Infection is a recognised but challenging complication of primary hip and knee arthroplasty. DAIR to be different: The Derby experienceĪ baseline audit into use of DAIR to treat infected joint arthroplasties ![]()
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