Outcome of debridement, antibiotics and implant retention for streptococcal hip and knee prosthetic joint infections: A systematic review and meta-analysis

Objectives: This systematic review and meta-analysis was conducted to assess the outcome of streptococcal hip and knee prosthetic joint infection (PJI) treated with Debridement, Antibiotics and Implant Retention (DAIR) and to evaluate risk factors associated with failure. Methods: We conducted a systematic literature search on PubMed, Embase, Web of Science, and Cochrane library from inception until October 2021. Random effects meta-analyses (i.e. relative risk) were used to estimate the success rate at the study level and its association with possible risk factors for failure with a specific focus on the use of rifampicin.Results: 25 observational studies were included, incorporating 1367 patients with streptococcal PJIs treated with DAIR. An overall pooled success rate of 71% (95% confidence interval (95%CI) 64-77%) was found for streptococcal PJI treated with DAIR. Treatment success was 76% (95%CI 62% to 91%) for knee PJI and 58% (95%CI 52% to 65%) for hip PJI. Treatment success differed for patients receiving rifampicin (84%, 95% CI 78% to 90%) compared to patients not receiving rifampicin (74%, 95% CI 63% to 85%), but this effect was no longer present in subsequent meta-analyses. Conclusions: The meta-analysis showed no clear benefit for rifampicin administration after DAIR for streptococcal PJI. Better outcome was observed for knee PJI compared to hip PJI.

Automated summary

This systematic review and meta-analysis evaluated the outcome of DAIR in treating streptococcal hip and knee prosthetic joint infection (PJI). The study included 25 observational studies with a total of 1367 patients. The overall success rate of streptococcal PJI treated with DAIR was 71%, with knee PJI showing a higher success rate (76%) compared to hip PJI (58%).