DAIR in treating chronic PJI after total knee arthroplasty using continuous local antibiotic perfusion therapy: a case series study
Abstract Background Antimicrobial agents are administered via intramedullary antibiotic perfusion (iMAP)/intrasoft tissue antibiotic perfusion (iSAP) to infected lesions to control osteoarticular and soft tissue infections. Continuous local antibiotic perfusion (CLAP) has been reported to be useful....
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-024-07165-y |
| _version_ | 1797363762970230784 |
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| author | Yukichi Zenke Yasuhito Motojima Kohei Ando Kenji Kosugi Daishi Hamada Yasuaki Okada Naohito Sato Daichi Shinohara Hitoshi Suzuki Makoto Kawasaki Akinori Sakai |
| author_facet | Yukichi Zenke Yasuhito Motojima Kohei Ando Kenji Kosugi Daishi Hamada Yasuaki Okada Naohito Sato Daichi Shinohara Hitoshi Suzuki Makoto Kawasaki Akinori Sakai |
| author_sort | Yukichi Zenke |
| collection | DOAJ |
| description | Abstract Background Antimicrobial agents are administered via intramedullary antibiotic perfusion (iMAP)/intrasoft tissue antibiotic perfusion (iSAP) to infected lesions to control osteoarticular and soft tissue infections. Continuous local antibiotic perfusion (CLAP) has been reported to be useful. This study aimed to investigate the outcomes of DAIR combined with CLAP for chronic PJI after total knee arthroplasty performed at our hospital. Subjects and methods Six patients (male; one case, female; five cases, mean age 79.5 years (70–94)) underwent CLAP for chronic PJI after TKA at our hospital between July 2020 and June 2022. They were followable for at least one year after surgery. Seven months (17–219), with a mean follow-up of 24.3 months (12–36). In addition to direct debridement and insert exchange, systemic antimicrobial treatment, and CLAP with gentamicin were performed using NPWT. We investigated the organisms causing the inflammation, the duration of iMAP/iSAP implantation, the maximum daily dose of GM, the maximum GM blood concentration, and the presence or absence of GM-induced adverse events. Result Two of six patients had a recurrence of infection at five weeks and five months after initial CLAP and required repeat CLAP treatment, but all patients could preserve their components. The organisms responsible for the flare-ups were MSSA in three cases: ESBL-producing E. coli, mixed MSSA and streptococcal infection, Klebsiella pneumonia in one case each, and unknown pathogens in one case. CLAP therapy for all patients was administered eight times in 6 cases: iMAP, mean: 10.0 days (5–16); iSAP, mean: 19.3 days (15–28); GM dose, mean: 162.5 mg/day (80–240); and GM blood concentration, mean: 1.4 µg/mL (0.2-5.0). Adverse events included one case of reversible acute kidney injury during CLAP in a patient with recurrent infection. Summary DAIR with CLAP for chronic post-TKA infection can be a useful treatment option to preserve components and allow the infection to subside, provided the implant is not markedly loosened. |
| first_indexed | 2024-03-08T16:25:42Z |
| format | Article |
| id | doaj.art-d08d5e4537ed4ce3bf3ded4634c4758a |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-03-08T16:25:42Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-d08d5e4537ed4ce3bf3ded4634c4758a2024-01-07T12:04:30ZengBMCBMC Musculoskeletal Disorders1471-24742024-01-0125111110.1186/s12891-024-07165-yDAIR in treating chronic PJI after total knee arthroplasty using continuous local antibiotic perfusion therapy: a case series studyYukichi Zenke0Yasuhito Motojima1Kohei Ando2Kenji Kosugi3Daishi Hamada4Yasuaki Okada5Naohito Sato6Daichi Shinohara7Hitoshi Suzuki8Makoto Kawasaki9Akinori Sakai10Department of Trauma Reconstruction, University of Occupational and Environmental HealthDepartment of Trauma Reconstruction, University of Occupational and Environmental HealthDepartment of Trauma Reconstruction, University of Occupational and Environmental HealthDepartment of Trauma Reconstruction, University of Occupational and Environmental HealthDepartment of Trauma Reconstruction, University of Occupational and Environmental HealthDepartment of Trauma Reconstruction, University of Occupational and Environmental HealthDepartment of Trauma Reconstruction, University of Occupational and Environmental HealthDepartment of Trauma Reconstruction, University of Occupational and Environmental HealthDepartment of Orthopaedic Surgery, University of Occupational and Environmental HealthDepartment of Orthopaedic Surgery, University of Occupational and Environmental HealthDepartment of Orthopaedic Surgery, University of Occupational and Environmental HealthAbstract Background Antimicrobial agents are administered via intramedullary antibiotic perfusion (iMAP)/intrasoft tissue antibiotic perfusion (iSAP) to infected lesions to control osteoarticular and soft tissue infections. Continuous local antibiotic perfusion (CLAP) has been reported to be useful. This study aimed to investigate the outcomes of DAIR combined with CLAP for chronic PJI after total knee arthroplasty performed at our hospital. Subjects and methods Six patients (male; one case, female; five cases, mean age 79.5 years (70–94)) underwent CLAP for chronic PJI after TKA at our hospital between July 2020 and June 2022. They were followable for at least one year after surgery. Seven months (17–219), with a mean follow-up of 24.3 months (12–36). In addition to direct debridement and insert exchange, systemic antimicrobial treatment, and CLAP with gentamicin were performed using NPWT. We investigated the organisms causing the inflammation, the duration of iMAP/iSAP implantation, the maximum daily dose of GM, the maximum GM blood concentration, and the presence or absence of GM-induced adverse events. Result Two of six patients had a recurrence of infection at five weeks and five months after initial CLAP and required repeat CLAP treatment, but all patients could preserve their components. The organisms responsible for the flare-ups were MSSA in three cases: ESBL-producing E. coli, mixed MSSA and streptococcal infection, Klebsiella pneumonia in one case each, and unknown pathogens in one case. CLAP therapy for all patients was administered eight times in 6 cases: iMAP, mean: 10.0 days (5–16); iSAP, mean: 19.3 days (15–28); GM dose, mean: 162.5 mg/day (80–240); and GM blood concentration, mean: 1.4 µg/mL (0.2-5.0). Adverse events included one case of reversible acute kidney injury during CLAP in a patient with recurrent infection. Summary DAIR with CLAP for chronic post-TKA infection can be a useful treatment option to preserve components and allow the infection to subside, provided the implant is not markedly loosened.https://doi.org/10.1186/s12891-024-07165-yContinuous local antibiotic perfusion therapy (CLAP)Chronic InfectionPostoperative total knee arthroplastyDebridementAntibioticsImplant retention (DAIR) |
| spellingShingle | Yukichi Zenke Yasuhito Motojima Kohei Ando Kenji Kosugi Daishi Hamada Yasuaki Okada Naohito Sato Daichi Shinohara Hitoshi Suzuki Makoto Kawasaki Akinori Sakai DAIR in treating chronic PJI after total knee arthroplasty using continuous local antibiotic perfusion therapy: a case series study BMC Musculoskeletal Disorders Continuous local antibiotic perfusion therapy (CLAP) Chronic Infection Postoperative total knee arthroplasty Debridement Antibiotics Implant retention (DAIR) |
| title | DAIR in treating chronic PJI after total knee arthroplasty using continuous local antibiotic perfusion therapy: a case series study |
| title_full | DAIR in treating chronic PJI after total knee arthroplasty using continuous local antibiotic perfusion therapy: a case series study |
| title_fullStr | DAIR in treating chronic PJI after total knee arthroplasty using continuous local antibiotic perfusion therapy: a case series study |
| title_full_unstemmed | DAIR in treating chronic PJI after total knee arthroplasty using continuous local antibiotic perfusion therapy: a case series study |
| title_short | DAIR in treating chronic PJI after total knee arthroplasty using continuous local antibiotic perfusion therapy: a case series study |
| title_sort | dair in treating chronic pji after total knee arthroplasty using continuous local antibiotic perfusion therapy a case series study |
| topic | Continuous local antibiotic perfusion therapy (CLAP) Chronic Infection Postoperative total knee arthroplasty Debridement Antibiotics Implant retention (DAIR) |
| url | https://doi.org/10.1186/s12891-024-07165-y |
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