DAIR to be different: The Derby experience

A baseline audit into use of DAIR to treat infected joint arthroplasties

  • Joshua Peake Royal Derby Hospital
  • Simon Cockshott Royal Derby Hospital

Abstract

DAIR to be different: The Derby experience


A baseline audit into use of DAIR to treat infected joint arthroplasties


Introduction: Infection is a recognised but challenging complication of primary hip and knee arthroplasty. Interventions include antibiotics, single-stage revision, two-stage revision, arthrodesis or amputation, or DAIR (debridement, antibiotics and implant retention). A microbiology MDT was set up to facilitate the management of patients with bone and joint infections to include an infectious disease and OPAT consultant, OPAT pharmacist and orthopaedic consultant. This provided a system by which antibiotic regimens could be initiated and altered, outpatient antibiotics delivered, and clinical response to treatment assessed. Method: A list of all patients undergoing DAIR from January 2017 to now was obtained from the microbiology MDT dynamic spreadsheet. An Excel spreadsheet was created and populated with data from iCM, PACS and patient notes. Results: A total of 14 DAIR procedures were performed (8 TKRs, 4 THRs, 1 UKR and 1 revision TKR) as recorded by the microbiology MDT in the time period. 5 were early infections, 3 delayed, and 6 late infections. All had open debridement, washout and exchange modular components, and 12 had antibiotic beads inserted. Mean highest pre-DAIR CRP was 197 (60-347) to mean baseline post-DAIR CRP of 7.65 (0.5-18). Mean time from diagnosis to DAIR was 2.3 days (not including a single outlier of 8 days). Isolated organisms included 8 streptococcus species, 4 staphylococcus species, and 1 enterococcus species. 13 out of 14 patients received at least six weeks of IV antibiotics. Oral antibiotic regimes after this were variable, with 6 patients having no oral antibiotics and the remainder receiving between 4 weeks and 2 having lifelong antibiotic suppression. 11 patients treated with a DAIR had no further open procedures. 1 patient required a repeat DAIR procedure, and 1 had a further debridement. 1 patient underwent subsequent revision arthroplasty. 1 patient had a subsequent manipulation under anaesthetic for stiffness. 12 out of 14 patients are off antibiotics completely. Recommendation: Although small numbers, the DAIR procedure seems to work well to prevent patients with infected arthroplasty requiring a revision operation. The microbiology MDT offers a robust way to facilitate antibiotic choice and delivery, and clinical correlation.

Published
2019-05-12
How to Cite
PEAKE, Joshua; COCKSHOTT, Simon. DAIR to be different: The Derby experience. Journal of Orthoplastic Surgery, [S.l.], v. 2, n. 2, may 2019. ISSN 2631-7982. Available at: <http://journaloforthoplasticsurgery.com/index.php/JOPS/article/view/42>. Date accessed: 20 july 2019.