Risk Factors of Marculescu et al for Treatment Failure Following Debridement and Retention of an Infected Orthopedic Component

 

Risk factors for failure of debridement and retention (Table 6, page 476):

(1) infection with Staphylococcus aureus

(2) duration of symptoms prior to debridement >= 8 days

(3) presence of a sinus tract

 

where:

• In univariate analysis the hazard ratio was 5 for Staphylococcus aureus, 2.9 for sinus tract and 1.8 for duration >= 8 days.

 

This requires aggressive monitoring, since initial symptoms may be subtle and a tendency to "watch and wait."

 

Other authors have reported treatment failure with gram negative bacilli. However, these can be successfully treated if therapy is done early after symptom onset.

 

Debridement and hardware retention most often is successful when the infecting organism is relatively avirulent and susceptible to oral antibiotics (page 471).