Polymicrobial Infection Is Associated with Failure of DAIR in Acute Hip Periprosthetic Joint Infection

BACKGROUND: Debridement, antibiotics, and implant retention (DAIR) is a commonly used tactic for the management of acute periprosthetic joint infection (PJI) following total hip arthroplasty. However, patient selection remains challenging, and predictors of treatment failure are not clearly defined. PATIENTS AND METHODS: A retrospective cohort study was conducted in a single center including 48 patients treated with DAIR for acute hip PJI between 2000 and 2019. Clinical characteristics, comorbidities, microbiological findings, and perioperative variables were analyzed. Treatment failure was defined as the need for implant removal or exchange, resection arthroplasty, or chronic suppressive antibiotic therapy. Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to explore factors associated with DAIR failure. RESULTS: The mean age was 69.3 years. At a mean follow-up of 23.7 months, infection control was achieved in 83.3% of cases. Polymicrobial infection was significantly associated with treatment failure compared with monomicrobial infection (57.1% vs. 87.5%, p = 0.049). An exploratory predictive model demonstrated acceptable to good discriminatory performance in this exploratory cohort for DAIR outcome (area under the curve = 0.87). CONCLUSIONS: DAIR is an effective treatment option for selected patients with acute hip PJI. Polymicrobial infection was associated with treatment failure and should prompt careful consideration of alternative surgical strategies. Exploratory risk stratification models may assist in preoperative decision-making; however, validation in larger cohorts is required.