Table 1_Analysis of failure causes and risk prediction of debridement, antibiotics, and implant retention (DAIR) for acute periprosthetic joint infection (PJI).docx

ObjectiveDebridement, antibiotics, and implant retention (DAIR) is the preferred treatment for acute periprosthetic joint infection (PJI), yet its failure rate remains high, and the influencing factors are not fully elucidated. This study aimed to investigate the causes of DAIR failure in acute PJI and construct a risk prediction model based on clinical characteristics, inflammatory markers, and microbiological data.
MethodsA retrospective analysis was conducted on 90 patients with acute PJI treated at our medical center between January 2008 and April 2024. All patients underwent standard DAIR treatment and were categorized into success (n = 77) and failure (n = 13) groups based on outcomes. Demographic data, infection characteristics, laboratory markers, microbiological results, and surgical details were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors, and a nomogram prediction model was developed.
ResultsThe overall success rate of DAIR was 85.6% (77/90). The failure group exhibited significantly higher rates of knee joint infection (84.6% vs. 50.6%, p=0.023), acute hematogenous infection (61.5% vs. 20.8%, p=0.005), preoperative peripheral White Blood Cell (WBC) (9.5×10^9/L vs. 8.2×10^9/L, p=0.043), CRP (79.6–4 mg/L vs. 42.4 mg/L, p<0.001), ESR (80.6 mm/h vs. 60.5 mm/h, p=0.002), synovial fluid WBC (35,300×10^6/L vs. 21,843×10^6/L, p=0.043), and synovial fluid polymorphonuclear leukocytes (PMNs) (91.7% vs. 83.8%, p<0.001) compared to the success group. Multivariate logistic regression identified acute hematogenous infection (OR 11.704, 95% CI 1.957–119.357, p=0.015), preoperative CRP (OR 1.022, 95% CI 1.009–1.040, p=0.003), synovial fluid PMN% (OR 1.196, 95% CI 1.039–1.454, p=0.039), and resistant pathogens (OR 0.107, 95% CI 0.010–0.665, p=0.032) as independent risk factors for DAIR failure. The nomogram model based on these factors demonstrated robust predictive performance.
ConclusionDAIR failure is closely associated with hematogenous infection, the intensity of inflammatory response, and the presence of resistant pathogens. The proposed risk prediction model may aid clinical decision-making and optimize patient selection for DAIR.

清创、抗生素治疗联合假体保留（Debridement, Antibiotics and Implant Retention, DAIR）是急性假体周围关节感染（Acute Periprosthetic Joint Infection, PJI）的首选治疗方案，但其失败率仍居高不下，且影响因素尚未完全阐明。本研究旨在探讨急性PJI患者行DAIR治疗失败的原因，并基于临床特征、炎症标志物及微生物学数据构建风险预测模型。
方法 本研究回顾性分析了2008年1月至2024年4月于本医疗中心接受治疗的90例急性PJI患者。所有患者均接受标准DAIR治疗，并根据治疗结局分为成功组（n=77）与失败组（n=13）。收集患者的人口学资料、感染特征、实验室指标、微生物学结果及手术细节。采用单因素及多因素logistic回归分析筛选独立危险因素，并构建列线图（Nomogram）预测模型。
结果 本研究中DAIR治疗的总体成功率为85.6%（77/90）。与成功组相比，失败组患者的膝关节感染率（84.6% vs. 50.6%，P=0.023）、急性血源性感染发生率（61.5% vs. 20.8%，P=0.005）、术前外周血白细胞（White Blood Cell, WBC）计数[9.5×10^9/L vs. 8.2×10^9/L，P=0.043]、C反应蛋白（C-reactive protein, CRP）[79.6 mg/L vs. 42.4 mg/L，P<0.001]、红细胞沉降率（Erythrocyte Sedimentation Rate, ESR）[80.6 mm/h vs. 60.5 mm/h，P=0.002]、滑液WBC计数[35300×10^6/L vs. 21843×10^6/L，P=0.043]及滑液多形核白细胞（Polymorphonuclear Leukocytes, PMNs）占比（91.7% vs. 83.8%，P<0.001）均显著升高。多因素logistic回归分析显示，急性血源性感染（比值比（Odds Ratio, OR）=11.704，95%CI：1.957~119.357，P=0.015）、术前CRP水平（OR=1.022，95%CI：1.009~1.040，P=0.003）、滑液PMNs占比（OR=1.196，95%CI：1.039~1.454，P=0.039）及耐药病原菌（OR=0.107，95%CI：0.010~0.665，P=0.032）为DAIR治疗失败的独立危险因素。基于上述因素构建的列线图模型展现出良好的预测性能。
结论 DAIR治疗失败与血源性感染、炎症反应强度及耐药病原菌的存在密切相关。本研究提出的风险预测模型可辅助临床决策，并优化DAIR治疗的患者筛选流程。