Bacteremia in Patients Undergoing Debridement, Antibiotics, and Implant Retention Leads to Increased Reinfections and Costs

Samuel Rosas; Vishal Hegde; F Johannes Plate; Douglas Dennis; Jason Jennings; Daniel N Bracey

doi:10.1016/j.artd.2022.05.014

Bacteremia in Patients Undergoing Debridement, Antibiotics, and Implant Retention Leads to Increased Reinfections and Costs

Arthroplast Today. 2022 Jul 19:16:259-263.e1. doi: 10.1016/j.artd.2022.05.014. eCollection 2022 Aug.

Authors

Samuel Rosas¹, Vishal Hegde^{2

3}, F Johannes Plate¹, Douglas Dennis^{2

4

5

6}, Jason Jennings^{2

4}, Daniel N Bracey^{2

7}

Affiliations

¹ Wake Forest Baptist Health, Department of Orthopaedic Surgery, Winston-Salem, NC USA.
² Colorado Joint Replacement, Denver, CO, USA.
³ The Johns Hopkins University, Department of Orthopaedic Surgery, Baltimore, MD, USA.
⁴ University of Denver, Department of Mechanical and Materials Engineering, Denver, CO, USA.
⁵ University of Colorado School of Medicine, Department of Orthopaedic Surgery, Aurora, CO, USA.
⁶ University of Tennessee, Department of Biomedical Engineering, Knoxville, TN, USA.
⁷ University of North Carolina, Department of Orthopaedic Surgery, Chapel Hill, NC, USA.

Abstract

Background: Debridement, antibiotics, and implant retention (DAIR) is a common treatment for acute prosthetic joint infection (PJI). The effects of concurrent bacteremia at the time of DAIR are poorly understood. This study sought to determine whether patients with bacteremia at the time of DAIR have higher reinfection rates.

Material and methods: A retrospective review of a national database was performed. Patients treated with DAIR (hip or knee arthroplasty) after a diagnosis of PJI were identified. DAIR patients who also had a diagnosis of bacteremia were matched to patients without bacteremia by comorbidities and Charlson Comorbidity Index score. The primary outcome was reinfection or continued infection at 90 days and 6, 12, and 24 months after DAIR. Ninety-day Medicare charges were compared between groups. Survival probabilities were used for survival comparisons.

Results: A total of 9945 patients underwent DAIR after a diagnosis of PJI. Seven hundred seven patients underwent DAIR with an associated diagnosis of bacteremia. Three hundred thirty-four DAIR patients with bacteremia were successfully matched to patients without bacteremia by age, gender, and comorbidities. DAIR survivorship was significantly worse in those with bacteremia at 90 days (51.5% vs 65.9%) and 6 (43.1% vs 60.5%), 12 (36.5% vs 56.0%), and 24 months (32.6% vs 53.3%) after DAIR. The 90-day costs of DAIR were significantly greater in PJI patients with bacteremia (mean: $14,722 standard deviation: $4086 vs mean: $8,052, standard deviation: $4,153, P < .01).

Conclusions: Patients undergoing DAIR with bacteremia are at an increased risk of reinfection or continued infection. Ninety-day costs are significantly increased (over 50%) in patients with bacteremia vs those without bacteremia.

Keywords: Arthroplasty; Infection; Prosthetic joint infection; Total hip arthroplasty; Total knee arthroplasty.