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Clinical Characteristics, Etiology, and Initial Management Strategy of Newly Diagnosed Periprosthetic Joint Infection: A Multicenter, Prospective Observational Cohort Study of 783 Patients

Manning, L, Metcalf, S, Clark, B, Robinson, JO, Huggan, P, Luey, C, McBride, S, Aboltins, C, Nelson, R, Campbell, D, Solomon, LB, Schneider, K, Loewenthal, M, Yates, P, Athan, Eugene, Cooper, D, Rad, B, Allworth, T, Reid, A, Read, K, Leung, P, Sud, A, Nagendra, V, Chean, R, Lemoh, C, Mutalima, N, Grimwade, K, Sehu, M, Torda, A, Aung, T, Graves, S, Paterson, D and Davis, J 2020, Clinical Characteristics, Etiology, and Initial Management Strategy of Newly Diagnosed Periprosthetic Joint Infection: A Multicenter, Prospective Observational Cohort Study of 783 Patients, Open Forum Infectious Diseases, vol. 7, no. 5, pp. 1-10, doi: 10.1093/ofid/ofaa068.

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Title Clinical Characteristics, Etiology, and Initial Management Strategy of Newly Diagnosed Periprosthetic Joint Infection: A Multicenter, Prospective Observational Cohort Study of 783 Patients
Author(s) Manning, L
Metcalf, S
Clark, B
Robinson, JO
Huggan, P
Luey, C
McBride, S
Aboltins, C
Nelson, R
Campbell, D
Solomon, LB
Schneider, K
Loewenthal, M
Yates, P
Athan, EugeneORCID iD for Athan, Eugene orcid.org/0000-0001-9838-6471
Cooper, D
Rad, B
Allworth, T
Reid, A
Read, K
Leung, P
Sud, A
Nagendra, V
Chean, R
Lemoh, C
Mutalima, N
Grimwade, K
Sehu, M
Torda, A
Aung, T
Graves, S
Paterson, D
Davis, J
Journal name Open Forum Infectious Diseases
Volume number 7
Issue number 5
Start page 1
End page 10
Total pages 10
Publisher Oxford University Press
Place of publication Oxford, Eng.
Publication date 2020-05
ISSN 2328-8957
2328-8957
Keyword(s) Science & Technology
Life Sciences & Biomedicine
Immunology
Infectious Diseases
Microbiology
arthroplasty infection
artificial joint infection
periprosthetic jo int infection
IMPLANT RETENTION
ANTIBIOTICS
DEBRIDEMENT
GUIDELINES
PREDICTORS
HIP
Summary Abstract Background Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. Most observational studies of PJI are retrospective or single-center, and reported management approaches and outcomes vary widely. We hypothesized that there would be substantial heterogeneity in PJI management and that most PJIs would present as late acute infections occurring as a consequence of bloodstream infections. Methods The Prosthetic joint Infection in Australia and New Zealand, Observational (PIANO) study is a prospective study at 27 hospitals. From July 2014 through December 2017, we enrolled all adults with a newly diagnosed PJI of a large joint. We collected data on demographics, microbiology, and surgical and antibiotic management over the first 3 months postpresentation. Results We enrolled 783 patients (427 knee, 323 hip, 25 shoulder, 6 elbow, and 2 ankle). The mode of presentation was late acute (>30 days postimplantation and <7 days of symptoms; 351, 45%), followed by early (≤30 days postimplantation; 196, 25%) and chronic (>30 days postimplantation with ≥30 days of symptoms; 148, 19%). Debridement, antibiotics, irrigation, and implant retention constituted the commonest initial management approach (565, 72%), but debridement was moderate or less in 142 (25%) and the polyethylene liner was not exchanged in 104 (23%). Conclusions In contrast to most studies, late acute infection was the most common mode of presentation, likely reflecting hematogenous seeding. Management was heterogeneous, reflecting the poor evidence base and the need for randomized controlled trials.
Language eng
DOI 10.1093/ofid/ofaa068
Indigenous content off
HERDC Research category C1 Refereed article in a scholarly journal
Free to Read? Yes
Persistent URL http://hdl.handle.net/10536/DRO/DU:30139641

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.