Debridement, Antibiotic Pearls, and Retention of the Implant (DAPRI) in the Treatment of Early Periprosthetic Joint Infections: A Consecutive Series
Introduction: Periprosthetic joint infections (PJI) represent a devastating consequence following total joint arthroplasty (TJA). In this study, the authors describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure (DAIR) to improve the possibilit...
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MDPI AG
2023-04-01
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| Series: | Pathogens |
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| Online Access: | https://www.mdpi.com/2076-0817/12/4/605 |
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| author | Pier Francesco Indelli Stefano Ghirardelli Pieralberto Valpiana Lorenzo Bini Michele Festini Ferdinando Iannotti |
| author_facet | Pier Francesco Indelli Stefano Ghirardelli Pieralberto Valpiana Lorenzo Bini Michele Festini Ferdinando Iannotti |
| author_sort | Pier Francesco Indelli |
| collection | DOAJ |
| description | Introduction: Periprosthetic joint infections (PJI) represent a devastating consequence following total joint arthroplasty (TJA). In this study, the authors describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure (DAIR) to improve the possibilities of retaining an acutely infected TJA. Materials and Methods: This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration by using calcium sulphate antibiotic-added beads in a setting of acute (<4 weeks from symptoms onset) PJI with pathogen identification. The combination of three different surgical techniques (tumor-like synovectomy, argon beam/acetic acid application and chlorhexidine gluconate brushing) aims to remove the bacterial biofilm from the implant without explanting the original hardware. Results: In total, 62 patients met the acute infection criteria (<4 weeks of symptoms); there were 57 males and five females. The patients’ average age at the time of treatment was 71 years (62–77) and the average BMI was 37 kg/m<sup>2</sup>. The micro-organism, always identified through synovial fluid analysis (culture, multiplex PCR or Next Generation Sequencing), was an aerobic Gram + in 76% (<i>S. Coag-Neg</i> 41%; <i>S. aureus</i> 16%), Gram—in 10% (<i>E. coli</i> 4%) and anaerobic Gram + in 4%. The DAPRI treatment was performed at an average of 3 days from symptoms onset (1–7 days). All patients underwent a 12-week course of post-operative antibiotic therapy (6 weeks I.V. and 6 weeks oral). All patients were available at the 2-year minimum FU (24–84 months). A total of 48 (77.5%) patients were infection-free at the final FU, while 14 patients underwent 2-stage revision for PJI recurrence. In total, four patients (6.4%) had a prolonged drainage from the wound after placement of the calcium sulphate beads. Conclusions: This study suggests that the DAPRI technique could represent a valid alternative to the classic DAIR procedure. The current authors do not recommend this procedure outside of the main inclusive criteria (acute scenario micro-organism identification). |
| first_indexed | 2024-03-11T04:38:58Z |
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| institution | Directory Open Access Journal |
| issn | 2076-0817 |
| language | English |
| last_indexed | 2024-03-11T04:38:58Z |
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| spelling | doaj.art-0d764bcad9a5431a91dcfac7042cceff2023-11-17T20:49:06ZengMDPI AGPathogens2076-08172023-04-0112460510.3390/pathogens12040605Debridement, Antibiotic Pearls, and Retention of the Implant (DAPRI) in the Treatment of Early Periprosthetic Joint Infections: A Consecutive SeriesPier Francesco Indelli0Stefano Ghirardelli1Pieralberto Valpiana2Lorenzo Bini3Michele Festini4Ferdinando Iannotti5Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA 94063, USAOrthoapedic Sports Medicine, University of Toronto, Toronto, ON M5S 1B2, CanadaSüdtiroler Sanitätsbetrieb, 39042 Brixen, ItalySchool of Medicine, University of Genova, 16132 Genova, ItalySüdtiroler Sanitätsbetrieb, 39042 Brixen, ItalyDepartment of Orthopaedic and Trauma Surgery, San Paolo Hospital, 00053 Civitavecchia, ItalyIntroduction: Periprosthetic joint infections (PJI) represent a devastating consequence following total joint arthroplasty (TJA). In this study, the authors describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure (DAIR) to improve the possibilities of retaining an acutely infected TJA. Materials and Methods: This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration by using calcium sulphate antibiotic-added beads in a setting of acute (<4 weeks from symptoms onset) PJI with pathogen identification. The combination of three different surgical techniques (tumor-like synovectomy, argon beam/acetic acid application and chlorhexidine gluconate brushing) aims to remove the bacterial biofilm from the implant without explanting the original hardware. Results: In total, 62 patients met the acute infection criteria (<4 weeks of symptoms); there were 57 males and five females. The patients’ average age at the time of treatment was 71 years (62–77) and the average BMI was 37 kg/m<sup>2</sup>. The micro-organism, always identified through synovial fluid analysis (culture, multiplex PCR or Next Generation Sequencing), was an aerobic Gram + in 76% (<i>S. Coag-Neg</i> 41%; <i>S. aureus</i> 16%), Gram—in 10% (<i>E. coli</i> 4%) and anaerobic Gram + in 4%. The DAPRI treatment was performed at an average of 3 days from symptoms onset (1–7 days). All patients underwent a 12-week course of post-operative antibiotic therapy (6 weeks I.V. and 6 weeks oral). All patients were available at the 2-year minimum FU (24–84 months). A total of 48 (77.5%) patients were infection-free at the final FU, while 14 patients underwent 2-stage revision for PJI recurrence. In total, four patients (6.4%) had a prolonged drainage from the wound after placement of the calcium sulphate beads. Conclusions: This study suggests that the DAPRI technique could represent a valid alternative to the classic DAIR procedure. The current authors do not recommend this procedure outside of the main inclusive criteria (acute scenario micro-organism identification).https://www.mdpi.com/2076-0817/12/4/605DAPRIperiprosthetic joint infectionsPJItotal knee arthroplastyinfectionTKA |
| spellingShingle | Pier Francesco Indelli Stefano Ghirardelli Pieralberto Valpiana Lorenzo Bini Michele Festini Ferdinando Iannotti Debridement, Antibiotic Pearls, and Retention of the Implant (DAPRI) in the Treatment of Early Periprosthetic Joint Infections: A Consecutive Series Pathogens DAPRI periprosthetic joint infections PJI total knee arthroplasty infection TKA |
| title | Debridement, Antibiotic Pearls, and Retention of the Implant (DAPRI) in the Treatment of Early Periprosthetic Joint Infections: A Consecutive Series |
| title_full | Debridement, Antibiotic Pearls, and Retention of the Implant (DAPRI) in the Treatment of Early Periprosthetic Joint Infections: A Consecutive Series |
| title_fullStr | Debridement, Antibiotic Pearls, and Retention of the Implant (DAPRI) in the Treatment of Early Periprosthetic Joint Infections: A Consecutive Series |
| title_full_unstemmed | Debridement, Antibiotic Pearls, and Retention of the Implant (DAPRI) in the Treatment of Early Periprosthetic Joint Infections: A Consecutive Series |
| title_short | Debridement, Antibiotic Pearls, and Retention of the Implant (DAPRI) in the Treatment of Early Periprosthetic Joint Infections: A Consecutive Series |
| title_sort | debridement antibiotic pearls and retention of the implant dapri in the treatment of early periprosthetic joint infections a consecutive series |
| topic | DAPRI periprosthetic joint infections PJI total knee arthroplasty infection TKA |
| url | https://www.mdpi.com/2076-0817/12/4/605 |
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