Objectives: To compare the characteristics and outcomes of cases with acute prosthetic joint infection (PJI; early post-surgical or hematogenous) by Staphylococcus aureus managed with implant removal (IRm) or debridement and retention (DAIR). To analyze the outcomes of all cases managed with IRm (initially or after DAIR failure). Methods: Retrospective, multicenter, cohort study of PJI by S. aureus (2003–2010). Overall failure included mortality within 60 days since surgery and local failure due to staphylococcal persistence/relapse. Results: 499 cases, 338 initially managed with DAIR, 161 with IRm. Mortality was higher in acute PJI managed initially with IRm compared to DAIR, but not associated with the surgical procedure, after propensity score matching. Underlying conditions, hemiarthroplasty, and methicillin-resistant S. aureus were risk factors for mortality. Finally, 249 cases underwent IRm (88 after DAIR failure); overall failure was 15.6%. Local failure (9.3%) was slightly higher in cases with several comorbidities, but independent of previous DAIR, type of IRm, and rifampin treatment. Conclusions: In a large multicenter study of S. aureus PJI managed with IRm, failure was low, but mortality significant, especially in cases with acute PJI and underlying conditions, but not associated with the IRm itself. Rifampin efficacy was limited in this setting.

中文翻译：

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金黄色葡萄球菌修复人工关节感染中的植入物去除：大型回顾性多中心研究的结果和失败的预测因素

目的：比较金黄色葡萄球菌经植入物清除（IRm）或清创和保留（DAIR）处理的急性假体关节感染（PJI；术后早期或血源性）的特征和结果。分析使用IRm管理的所有病例的结果（最初或在DAIR失败后）。方法：金黄色葡萄球菌对PJI的回顾性，多中心，队列研究（2003年-2010年）。总体衰竭包括手术后60天内的死亡率和葡萄球菌持续性/复发引起的局部衰竭。结果：499例，最初使用DAIR处理338例，使用IRm处理161例。倾向评分匹配后，最初由IRm处理的急性PJI患者的死亡率高于DAIR，但与手术方法无关。基本情况，半髋关节置换术和耐甲氧西林的金黄色葡萄球菌是导致死亡的危险因素。最后，有249例患者接受了IRm治疗（DAIR失败后为88例）；整体失败率为15.6％。在有多种合并症的情况下，局部衰竭（9.3％）略高，但与先前的DAIR，IRm类型和利福平治疗无关。结论：在金黄色葡萄球菌的大型多中心研究中PJI用IRm治疗，失败率低，但死亡率显着，特别是在急性PJI和潜在疾病但与IRm本身无关的情况下。在这种情况下，利福平疗效有限。