{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:35:30Z","timestamp":1787754930323,"version":"build-2784847793"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2019,4,17]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Acute periprosthetic joint infection (PJI) is difficult to treat. In this study, we investigated the failure rates of irrigation and debridement (I&amp;D) among patients with acute post-surgical and acute hematogenous PJI, and explored various host and organism-related risk factors that may be associated with treatment failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We retrospectively reviewed the cases of 199 total joint arthroplasty patients who underwent I&amp;D for acute post-surgical PJI (&lt;3 months postoperatively) and acute hematogenous PJI (\u22653 months postoperatively, with abrupt symptoms lasting &lt;3 weeks) at a single center during the period of 2005 to 2016. Only patients meeting the Musculoskeletal Infection Society (MSIS) criteria for PJI were included. Patient demographics, comorbidities, physical examination findings, laboratory results, and organism profile were identified. Treatment failure, as defined by the Delphi criteria, was determined for 1-year follow-up. Primary statistical analysis involved univariate and multivariate regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The failure rate was 37.7% (75 of 199) at 1 year. Among the patients with acute hematogenous infections, the rate of failure (56%, 29 of 52) was almost 2 times higher than that of patients with acute post-surgical infections (31%, 46 of 147) (adjusted odds ratio [OR], 2.36; 95% confidence interval [CI], 1.16 to 4.81; p = 0.018). Host predictors of failure included prior revision surgery (adjusted OR, 2.55; 95% CI, 1.22 to 5.32; p = 0.013) and a higher Charlson Comorbidity Index (adjusted OR, 1.22; 95% CI, 1.01 to 1.51; p = 0.048). Specific comorbidities associated with failure included chronic obstructive pulmonary disease (p = 0.026), diabetes (p = 0.004), and a history of malignancy (p = 0.005). Patients with polymicrobial infections (adjusted OR, 2.40; 95% CI, 1.10 to 5.20; p = 0.028) were also more likely to experience failure of treatment after I&amp;D. The clinical and laboratory risk factors associated with failure were the presence of intraoperative purulence (p = 0.05), elevated systolic blood pressure (p = 0.05), tachycardia (p = 0.06), and higher serum C-reactive protein level (p = 0.003).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This study revealed that I&amp;D is associated with a high rate of failure for patients with an acute hematogenous PJI. The study also identified a number of risk factors for failure. The findings of this study may allow better decision-making by surgeons regarding the surgical management of patients with acute PJI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.18.00381","type":"journal-article","created":{"date-parts":[[2019,4,25]],"date-time":"2019-04-25T11:56:11Z","timestamp":1556193371000},"page":"696-703","source":"Crossref","is-referenced-by-count":48,"title":["Increased Failure After Irrigation and Debridement for Acute Hematogenous Periprosthetic Joint Infection"],"prefix":"10.2106","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7759-1641","authenticated-orcid":false,"given":"Noam","family":"Shohat","sequence":"first","affiliation":[{"name":"The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0217-4752","authenticated-orcid":false,"given":"Karan","family":"Goswami","sequence":"additional","affiliation":[{"name":"The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2015-3162","authenticated-orcid":false,"given":"Timothy L.","family":"Tan","sequence":"additional","affiliation":[{"name":"The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6626-9913","authenticated-orcid":false,"given":"Yale","family":"Fillingham","sequence":"additional","affiliation":[{"name":"The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6985-5870","authenticated-orcid":false,"given":"Javad","family":"Parvizi","sequence":"additional","affiliation":[{"name":"The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,4,17]]},"reference":[{"issue":"2S","key":"bib1-20230810","first-page":"84","article-title":"Acute periprosthetic knee infection: is there still a role for DAIR?","volume":"88","author":"Di Benedetto","year":"2017","journal-title":"Acta Biomed."},{"issue":"9","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"659","DOI":"10.3928\/01477447-20100722-42","article-title":"Periprosthetic joint infection: treatment options","volume":"33","author":"Parvizi","year":"2010","journal-title":"Orthopedics."},{"issue":"8","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"2024","DOI":"10.1007\/s11999-010-1291-y","article-title":"Irrigation and d\u00e9bridement and prosthesis retention for treating acute periprosthetic infections","volume":"468","author":"Van Kleunen","year":"2010","journal-title":"Clin Orthop Relat Res."},{"issue":"5","key":"bib4-20230810","doi-asserted-by":"crossref","first-page":"667","DOI":"10.5312\/wjo.v5.i5.667","article-title":"Treatment of acute periprosthetic infections with prosthesis retention: review of current concepts","volume":"5","author":"Kuiper","year":"2014","journal-title":"World J Orthop."},{"issue":"1","key":"bib5-20230810","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/cid\/cis966","article-title":"Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America","volume":"56","author":"Osmon","year":"2013","journal-title":"Clin Infect Dis."},{"issue":"3","key":"bib6-20230810","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.arth.2013.07.021","article-title":"Acute hematogenous infection following total hip and knee arthroplasty","volume":"29","author":"Konigsberg","year":"2014","journal-title":"J Arthroplasty."},{"issue":"4","key":"bib7-20230810","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1086\/499234","article-title":"Outcome of prosthetic joint infections treated with debridement and retention of components","volume":"42","author":"Marculescu","year":"2006","journal-title":"Clin Infect Dis."},{"issue":"11","key":"bib8-20230810","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.1111\/j.1469-0691.2010.03333.x","article-title":"Early prosthetic joint infection: outcomes with debridement and implant retention followed by antibiotic therapy","volume":"17","author":"Cobo","year":"2011","journal-title":"Clin Microbiol Infect."},{"issue":"3","key":"bib9-20230810","doi-asserted-by":"crossref","first-page":"227","DOI":"10.3109\/17453674.2012.678801","article-title":"Early prosthetic joint infections treated with debridement and implant retention: 38 primary hip arthroplasties prospectively recorded and followed for median 4 years","volume":"83","author":"Westberg","year":"2012","journal-title":"Acta Orthop."},{"issue":"11","key":"bib10-20230810","doi-asserted-by":"crossref","first-page":"3043","DOI":"10.1007\/s11999-011-1910-2","article-title":"Infection control rate of irrigation and d\u00e9bridement for periprosthetic joint infection","volume":"469","author":"Koyonos","year":"2011","journal-title":"Clin Orthop Relat Res."},{"issue":"6","key":"bib11-20230810","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1093\/jac\/dkp107","article-title":"One hundred and twelve infected arthroplasties treated with \u2018DAIR\u2019 (debridement, antibiotics and implant retention): antibiotic duration and outcome","volume":"63","author":"Byren","year":"2009","journal-title":"J Antimicrob Chemother."},{"issue":"7","key":"bib12-20230810","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.arth.2010.01.104","article-title":"Irrigation and debridement in the management of prosthetic joint infection: traditional indications revisited","volume":"25","author":"Azzam","year":"2010","journal-title":"J Arthroplasty."},{"issue":"6","key":"bib13-20230810","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.arth.2011.03.031","article-title":"Periprosthetic Infection Consortium. Irrigation and debridement for periprosthetic infections: does the organism matter?","volume":"26","author":"Odum","year":"2011","journal-title":"J Arthroplasty."},{"issue":"11","key":"bib14-20230810","doi-asserted-by":"crossref","first-page":"3164","DOI":"10.1007\/s11999-012-2500-7","article-title":"Aggressive early d\u00e9bridement for treatment of acutely infected cemented total hip arthroplasty","volume":"470","author":"Sukeik","year":"2012","journal-title":"Clin Orthop Relat Res."},{"issue":"11","key":"bib15-20230810","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1302\/0301-620X.95B11.33135","article-title":"Proceedings of the International Consensus on Periprosthetic Joint Infection","volume":"95-B","author":"Parvizi","year":"2013","journal-title":"Bone Joint J."},{"issue":"1","key":"bib16-20230810","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s11999-010-1434-1","article-title":"Periprosthetic Infection Consortium. The Chitranjan Ranawat Award: fate of two-stage reimplantation after failed irrigation and d\u00e9bridement for periprosthetic knee infection","volume":"469","author":"Sherrell","year":"2011","journal-title":"Clin Orthop Relat Res."},{"issue":"4","key":"bib17-20230810","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1007\/s11999-010-1417-2","article-title":"Can this prosthesis be saved?: implant salvage attempts in infected primary TKA","volume":"469","author":"Gardner","year":"2011","journal-title":"Clin Orthop Relat Res."},{"issue":"11","key":"bib18-20230810","doi-asserted-by":"crossref","first-page":"2992","DOI":"10.1007\/s11999-011-2102-9","article-title":"New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society","volume":"469","author":"Parvizi","year":"2011","journal-title":"Clin Orthop Relat Res."},{"issue":"7","key":"bib19-20230810","doi-asserted-by":"crossref","first-page":"2374","DOI":"10.1007\/s11999-013-2866-1","article-title":"Success after treatment of periprosthetic joint infection: a Delphi-based international multidisciplinary consensus","volume":"471","author":"Diaz-Ledezma","year":"2013","journal-title":"Clin Orthop Relat Res."},{"issue":"Suppl 8","key":"bib20-20230810","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.5301\/HIP.2012.9566","article-title":"Value of debridement and irrigation for the treatment of peri-prosthetic infections. A systematic review","volume":"22","author":"Roman\u00f2","year":"2012","journal-title":"Hip Int."},{"issue":"6","key":"bib21-20230810","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.arth.2009.04.028","article-title":"The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components","volume":"24","author":"Bradbury","year":"2009","journal-title":"J Arthroplasty."},{"key":"bib22-20230810","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1097\/00003086-199112000-00016","article-title":"Periprosthetic knee sepsis. The role of irrigation and debridement","volume":"273","author":"Hartman","year":"1991","journal-title":"Clin Orthop Relat Res."},{"issue":"5","key":"bib23-20230810","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1093\/clinids\/24.5.914","article-title":"Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention","volume":"24","author":"Brandt","year":"1997","journal-title":"Clin Infect Dis."},{"key":"bib24-20230810","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1097\/00003086-199112000-00015","article-title":"Implant salvage in infected total knee arthroplasty","volume":"273","author":"Burger","year":"1991","journal-title":"Clin Orthop Relat Res."},{"issue":"9","key":"bib25-20230810","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.2106\/00004623-199072090-00018","article-title":"Treatment of infection after total knee arthroplasty by d\u00e9bridement with retention of the components","volume":"72","author":"Schoifet","year":"1990","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib26-20230810","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1086\/520202","article-title":"Prosthetic joint infection: when can prosthesis salvage be considered?","volume":"29","author":"Tattevin","year":"1999","journal-title":"Clin Infect Dis."},{"issue":"1","key":"bib27-20230810","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/S0883-5403(06)80007-0","article-title":"Treatment of infected total knee arthroplasty. Irrigation and debridement versus two-stage reimplantation","volume":"5","author":"Teeny","year":"1990","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib28-20230810","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.amjmed.2015.09.006","article-title":"Clinical presentation, risk factors, and outcomes of hematogenous prosthetic joint infection in patients with Staphylococcus aureus bacteremia","volume":"129","author":"Tande","year":"2016","journal-title":"Am J Med."},{"issue":"2","key":"bib29-20230810","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1093\/cid\/cis746","article-title":"REIPI Group for the Study of Prosthetic Infection. A large multicenter study of methicillin-susceptible and methicillin-resistant Staphylococcus aureus prosthetic joint infections managed with implant retention","volume":"56","author":"Lora-Tamayo","year":"2013","journal-title":"Clin Infect Dis."},{"issue":"11","key":"bib30-20230810","doi-asserted-by":"crossref","first-page":"2331","DOI":"10.1016\/j.biomaterials.2005.11.044","article-title":"The significance of infection related to orthopedic devices and issues of antibiotic resistance","volume":"27","author":"Campoccia","year":"2006","journal-title":"Biomaterials."},{"issue":"6","key":"bib31-20230810","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1080\/17453670710014527","article-title":"Risk factors associated with acute hip prosthetic joint infections and outcome of treatment with a rifampinbased regimen","volume":"78","author":"Choong","year":"2007","journal-title":"Acta Orthop."},{"issue":"12","key":"bib32-20230810","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1002\/art.24060","article-title":"Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis","volume":"59","author":"Bongartz","year":"2008","journal-title":"Arthritis Rheum."},{"issue":"1","key":"bib33-20230810","doi-asserted-by":"crossref","first-page":"38","DOI":"10.2106\/JBJS.G.01686","article-title":"Risk factors for infection after knee arthroplasty. A register-based analysis of 43,149 cases","volume":"91","author":"J\u00e4msen","year":"2009","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib34-20230810","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/j.cmi.2015.04.012","article-title":"KLIC-score for predicting early failure in prosthetic joint infections treated with debridement, implant retention and antibiotics","volume":"21","author":"Tornero","year":"2015","journal-title":"Clin Microbiol Infect."},{"issue":"11","key":"bib35-20230810","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1111\/1469-0691.12721","article-title":"European Society Group of Infections on Artificial Implants (ESGIAI). Characteristics of prosthetic joint infections due to Enterococcus sp. and predictors of failure: a multi-national study","volume":"20","author":"Tornero","year":"2014","journal-title":"Clin Microbiol Infect."},{"issue":"7","key":"bib36-20230810","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/S0883-5403(03)00288-2","article-title":"Limited success with open debridement and retention of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty","volume":"18","author":"Deirmengian","year":"2003","journal-title":"J Arthroplasty."},{"issue":"3","key":"bib37-20230810","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1111\/j.1469-0691.2010.03244.x","article-title":"Outcome and predictors of treatment failure in early post-surgical prosthetic joint infections due to Staphylococcus aureus treated with debridement","volume":"17","author":"Vilchez","year":"2011","journal-title":"Clin Microbiol Infect."},{"issue":"9","key":"bib38-20230810","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1007\/s00264-015-2819-2","article-title":"Predictors of treatment outcome in prosthetic joint infections treated with prosthesis retention","volume":"39","author":"Puhto","year":"2015","journal-title":"Int Orthop."},{"issue":"6","key":"bib39-20230810","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1007\/s00402-015-2237-3","article-title":"Open debridement and prosthesis retention is a viable treatment option for acute periprosthetic joint infection after total knee arthroplasty","volume":"135","author":"Koh","year":"2015","journal-title":"Arch Orthop Trauma Surg."},{"issue":"12","key":"bib40-20230810","doi-asserted-by":"crossref","first-page":"1742","DOI":"10.1093\/cid\/cix227","article-title":"Group of Investigators for Streptococcal Prosthetic Joint Infection. The not-so-good prognosis of streptococcal periprosthetic joint infection managed by implant retention: the results of a large multicenter study","volume":"64","author":"Lora-Tamayo","year":"2017","journal-title":"Clin Infect Dis."},{"issue":"11","key":"bib41-20230810","doi-asserted-by":"crossref","first-page":"O911","DOI":"10.1111\/1469-0691.12649","article-title":"REIPI Group for the Study of Prosthetic Infection. Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study","volume":"20","author":"Rodr\u00edguez-Pardo","year":"2014","journal-title":"Clin Microbiol Infect."},{"issue":"23","key":"bib42-20230810","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.2106\/JBJS.16.01103","article-title":"Irrigation and debridement with component retention for acute infection after hip arthroplasty: improved results with contemporary management","volume":"99","author":"Bryan","year":"2017","journal-title":"J Bone Joint Surg Am."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201904170-00005","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:35:03Z","timestamp":1787751303000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201904170-00005"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,17]]},"references-count":42,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.18.00381","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,17]]}}}