Table 4.

Univariate and Multivariate Analysis of Parameters Predicting Early Failure, Late Failure and Failure After Therapy

Early Failure (n = 444, 55 Failures)bLate Failure (n = 389, 71 Failures)cFailure After Therapy (N = 318, 61 Failures)d
OR (95% CI)PaOR (95%CI)PHR (95%CI)PaHR (95% CI)PHR (95%CI)PaHR (95% CI)P
Sex (female)1.19 (0.68–2.10).5400.50 (0.31–0.81).0040.51 (0.30–0.85).0091.16 (0.69–1.92).572
Age (per year)1.03 (0.99–1.01).0761.04 (1.00–1.07).0271.00 (0.98–1.02).9950.99 (0.97–1.01).348
Rheumatoid arthritis2.98 (1.35–6.56).0073.33 (1.40–7.93).0072.95 (1.55–5.62).004--1.19 (0.37–3.81).772
Immunosuppressive therapy1.49 (0.66–3.66).3432.76 (1.56–4.89).0022.64 (1.46–4.79).0011.51 (0.65–3.51).363
Renal chronic disease1.67 (0.73–3.81).2231.99 (1.05–3.79).053--1.17 (0.47–2.91).746
Prosthesis location (knee)1.04 (0.86–1.26).6770.98 (0.83–1.14).7531.18 (0.98–1.41).073--
Revision prosthesis1.53 (0.83–2.81).1731.78 (1.09–2.91).0271.77 (1.07–2.93).0271.56 (0.90–2.70).129
Chronic post-surgical inf.e1.212 (0.97–1.23).0911.41 (1.10–1.81).0071.12 (0.92–1.37).2561.47 (1.22–1.77)<.0012.24 (1.24–4.05).008
Sinus tract0.75 (0.31–1.84).5291.05 (0.54–2.06).8811.61 (0.84–3.11).175
Bacteremia2.17 (1.20–3.92).0112.23 (1.80–4.20).0141.24 (0.74–2.06).4201.23 (0.70–2.19).478
Rx signs of infection1.16 (0.98–1.39).091--0.77 (0.40–1.48).4212.21 (1.14–4.30).025--
Infection by S. pyogenes3.10 (1.41–6.85).0053.31 (1.41–7.77).0060.60 (0.19–1.92).3571.11 (0.45–2.78).821
Infection by virdidans streptococci0.71 (0.32–1.57).4011.60 (0.94–2.70).0941.01 (0.51–1.98).987
Polymicrobial infection0.95 (0.41–2.20).8961.33 (0.71–2.47).3851.23 (0.61–2.49).579
Time to debridement (>7 days)a0.96 (0.54–1.72).8991.60 (1.00–2.54)a.0501.70 (1.05–2.75).0331.33 (0.80–2.20)0.281
Exchange of polyethylene0.56 (0.31–1.02).0590.75 (0.46–1.21).2340.45 (0.26–0.77).0330.44 (0.26–0.76).003
Need for ≥2 debridements1.16 (0.57–2.36).6832.26 (1.63–4.36)<.0012.45 (1.45–4.15).0010.60 (0.26–1.40).206
Antimicrobial therapy‡
 Β-lactams (without rifampin)1.41 (0.88–2.27).1550.62 (0.37–1.03).0610.48 (0.28–0.84).010
 β-lactams + rifampin0.89 (0.47–1.70).7240.42 (0.18–0.98).0250.34 (0.12–0.96).041
 Quinolones + rifampin0.19 (0.03–1.36).0820.21 (0.03–1.54).1251.03 (0.45–2.40).940
 Glycopeptides without rifampin3.97 (2.08–7.58)<.0012.82 (1.43–5.53).0034.25 (1.32–13.7).015
 Duration of therapy >120 days0.54 (0.29–0.90).046
Early Failure (n = 444, 55 Failures)bLate Failure (n = 389, 71 Failures)cFailure After Therapy (N = 318, 61 Failures)d
OR (95% CI)PaOR (95%CI)PHR (95%CI)PaHR (95% CI)PHR (95%CI)PaHR (95% CI)P
Sex (female)1.19 (0.68–2.10).5400.50 (0.31–0.81).0040.51 (0.30–0.85).0091.16 (0.69–1.92).572
Age (per year)1.03 (0.99–1.01).0761.04 (1.00–1.07).0271.00 (0.98–1.02).9950.99 (0.97–1.01).348
Rheumatoid arthritis2.98 (1.35–6.56).0073.33 (1.40–7.93).0072.95 (1.55–5.62).004--1.19 (0.37–3.81).772
Immunosuppressive therapy1.49 (0.66–3.66).3432.76 (1.56–4.89).0022.64 (1.46–4.79).0011.51 (0.65–3.51).363
Renal chronic disease1.67 (0.73–3.81).2231.99 (1.05–3.79).053--1.17 (0.47–2.91).746
Prosthesis location (knee)1.04 (0.86–1.26).6770.98 (0.83–1.14).7531.18 (0.98–1.41).073--
Revision prosthesis1.53 (0.83–2.81).1731.78 (1.09–2.91).0271.77 (1.07–2.93).0271.56 (0.90–2.70).129
Chronic post-surgical inf.e1.212 (0.97–1.23).0911.41 (1.10–1.81).0071.12 (0.92–1.37).2561.47 (1.22–1.77)<.0012.24 (1.24–4.05).008
Sinus tract0.75 (0.31–1.84).5291.05 (0.54–2.06).8811.61 (0.84–3.11).175
Bacteremia2.17 (1.20–3.92).0112.23 (1.80–4.20).0141.24 (0.74–2.06).4201.23 (0.70–2.19).478
Rx signs of infection1.16 (0.98–1.39).091--0.77 (0.40–1.48).4212.21 (1.14–4.30).025--
Infection by S. pyogenes3.10 (1.41–6.85).0053.31 (1.41–7.77).0060.60 (0.19–1.92).3571.11 (0.45–2.78).821
Infection by virdidans streptococci0.71 (0.32–1.57).4011.60 (0.94–2.70).0941.01 (0.51–1.98).987
Polymicrobial infection0.95 (0.41–2.20).8961.33 (0.71–2.47).3851.23 (0.61–2.49).579
Time to debridement (>7 days)a0.96 (0.54–1.72).8991.60 (1.00–2.54)a.0501.70 (1.05–2.75).0331.33 (0.80–2.20)0.281
Exchange of polyethylene0.56 (0.31–1.02).0590.75 (0.46–1.21).2340.45 (0.26–0.77).0330.44 (0.26–0.76).003
Need for ≥2 debridements1.16 (0.57–2.36).6832.26 (1.63–4.36)<.0012.45 (1.45–4.15).0010.60 (0.26–1.40).206
Antimicrobial therapy‡
 Β-lactams (without rifampin)1.41 (0.88–2.27).1550.62 (0.37–1.03).0610.48 (0.28–0.84).010
 β-lactams + rifampin0.89 (0.47–1.70).7240.42 (0.18–0.98).0250.34 (0.12–0.96).041
 Quinolones + rifampin0.19 (0.03–1.36).0820.21 (0.03–1.54).1251.03 (0.45–2.40).940
 Glycopeptides without rifampin3.97 (2.08–7.58)<.0012.82 (1.43–5.53).0034.25 (1.32–13.7).015
 Duration of therapy >120 days0.54 (0.29–0.90).046

Abbreviations: aHR, adjusted hazard ratio; aOR, adjusted odds ratio; CI, confidence interval; HR, hazard ratio; OR, odds ratio.

aTime to debridement: time from onset of symptoms to the first surgical debridement. Initial models of multivariate analyses were built with variables with a P value < .10 in the univariate analysis and then selected with a stepwise backward process.

bEarly Failure: the initial multivariate model included age, rheumatoid arthritis, late post-surgical infections, Rx signs of infection, infection by S. pyogenes, and bacteremia.

cLate Failure: the initial multivariate model included sex, rheumatoid arthritis, immunosuppressant therapy, chronic renal disease, infection by S. viridians, time to debridement, need for ≥2 debridements, treatment with quinolones plus rifampin, and treatment with glycopeptides without rifampin.

dFailure After Therapy: the initial multivariate model included prosthesis location, late post-surgical infection, Rx signs of infection, exchange of removable components (i.e., polyethylene liner), treatment with beta-lactams (without rifampin), treatment with beta-lactams plus rifampin, and treatment with glycopeptides without rifampin.

e Non-hematogenous infection with symptoms beginning beyond 90 days after the prosthesis placement.

‡Treatments included in the analysis of Late Failure are those received during the first 30 days after debridement and are considered if they were administered for at least 15 days; treatments included in the analysis of Failure After Therapy are those received during the whole period of treatment, both orally and intravenously, and are considered if they were administered for at least 22 days.

Table 4.

Univariate and Multivariate Analysis of Parameters Predicting Early Failure, Late Failure and Failure After Therapy

Early Failure (n = 444, 55 Failures)bLate Failure (n = 389, 71 Failures)cFailure After Therapy (N = 318, 61 Failures)d
OR (95% CI)PaOR (95%CI)PHR (95%CI)PaHR (95% CI)PHR (95%CI)PaHR (95% CI)P
Sex (female)1.19 (0.68–2.10).5400.50 (0.31–0.81).0040.51 (0.30–0.85).0091.16 (0.69–1.92).572
Age (per year)1.03 (0.99–1.01).0761.04 (1.00–1.07).0271.00 (0.98–1.02).9950.99 (0.97–1.01).348
Rheumatoid arthritis2.98 (1.35–6.56).0073.33 (1.40–7.93).0072.95 (1.55–5.62).004--1.19 (0.37–3.81).772
Immunosuppressive therapy1.49 (0.66–3.66).3432.76 (1.56–4.89).0022.64 (1.46–4.79).0011.51 (0.65–3.51).363
Renal chronic disease1.67 (0.73–3.81).2231.99 (1.05–3.79).053--1.17 (0.47–2.91).746
Prosthesis location (knee)1.04 (0.86–1.26).6770.98 (0.83–1.14).7531.18 (0.98–1.41).073--
Revision prosthesis1.53 (0.83–2.81).1731.78 (1.09–2.91).0271.77 (1.07–2.93).0271.56 (0.90–2.70).129
Chronic post-surgical inf.e1.212 (0.97–1.23).0911.41 (1.10–1.81).0071.12 (0.92–1.37).2561.47 (1.22–1.77)<.0012.24 (1.24–4.05).008
Sinus tract0.75 (0.31–1.84).5291.05 (0.54–2.06).8811.61 (0.84–3.11).175
Bacteremia2.17 (1.20–3.92).0112.23 (1.80–4.20).0141.24 (0.74–2.06).4201.23 (0.70–2.19).478
Rx signs of infection1.16 (0.98–1.39).091--0.77 (0.40–1.48).4212.21 (1.14–4.30).025--
Infection by S. pyogenes3.10 (1.41–6.85).0053.31 (1.41–7.77).0060.60 (0.19–1.92).3571.11 (0.45–2.78).821
Infection by virdidans streptococci0.71 (0.32–1.57).4011.60 (0.94–2.70).0941.01 (0.51–1.98).987
Polymicrobial infection0.95 (0.41–2.20).8961.33 (0.71–2.47).3851.23 (0.61–2.49).579
Time to debridement (>7 days)a0.96 (0.54–1.72).8991.60 (1.00–2.54)a.0501.70 (1.05–2.75).0331.33 (0.80–2.20)0.281
Exchange of polyethylene0.56 (0.31–1.02).0590.75 (0.46–1.21).2340.45 (0.26–0.77).0330.44 (0.26–0.76).003
Need for ≥2 debridements1.16 (0.57–2.36).6832.26 (1.63–4.36)<.0012.45 (1.45–4.15).0010.60 (0.26–1.40).206
Antimicrobial therapy‡
 Β-lactams (without rifampin)1.41 (0.88–2.27).1550.62 (0.37–1.03).0610.48 (0.28–0.84).010
 β-lactams + rifampin0.89 (0.47–1.70).7240.42 (0.18–0.98).0250.34 (0.12–0.96).041
 Quinolones + rifampin0.19 (0.03–1.36).0820.21 (0.03–1.54).1251.03 (0.45–2.40).940
 Glycopeptides without rifampin3.97 (2.08–7.58)<.0012.82 (1.43–5.53).0034.25 (1.32–13.7).015
 Duration of therapy >120 days0.54 (0.29–0.90).046
Early Failure (n = 444, 55 Failures)bLate Failure (n = 389, 71 Failures)cFailure After Therapy (N = 318, 61 Failures)d
OR (95% CI)PaOR (95%CI)PHR (95%CI)PaHR (95% CI)PHR (95%CI)PaHR (95% CI)P
Sex (female)1.19 (0.68–2.10).5400.50 (0.31–0.81).0040.51 (0.30–0.85).0091.16 (0.69–1.92).572
Age (per year)1.03 (0.99–1.01).0761.04 (1.00–1.07).0271.00 (0.98–1.02).9950.99 (0.97–1.01).348
Rheumatoid arthritis2.98 (1.35–6.56).0073.33 (1.40–7.93).0072.95 (1.55–5.62).004--1.19 (0.37–3.81).772
Immunosuppressive therapy1.49 (0.66–3.66).3432.76 (1.56–4.89).0022.64 (1.46–4.79).0011.51 (0.65–3.51).363
Renal chronic disease1.67 (0.73–3.81).2231.99 (1.05–3.79).053--1.17 (0.47–2.91).746
Prosthesis location (knee)1.04 (0.86–1.26).6770.98 (0.83–1.14).7531.18 (0.98–1.41).073--
Revision prosthesis1.53 (0.83–2.81).1731.78 (1.09–2.91).0271.77 (1.07–2.93).0271.56 (0.90–2.70).129
Chronic post-surgical inf.e1.212 (0.97–1.23).0911.41 (1.10–1.81).0071.12 (0.92–1.37).2561.47 (1.22–1.77)<.0012.24 (1.24–4.05).008
Sinus tract0.75 (0.31–1.84).5291.05 (0.54–2.06).8811.61 (0.84–3.11).175
Bacteremia2.17 (1.20–3.92).0112.23 (1.80–4.20).0141.24 (0.74–2.06).4201.23 (0.70–2.19).478
Rx signs of infection1.16 (0.98–1.39).091--0.77 (0.40–1.48).4212.21 (1.14–4.30).025--
Infection by S. pyogenes3.10 (1.41–6.85).0053.31 (1.41–7.77).0060.60 (0.19–1.92).3571.11 (0.45–2.78).821
Infection by virdidans streptococci0.71 (0.32–1.57).4011.60 (0.94–2.70).0941.01 (0.51–1.98).987
Polymicrobial infection0.95 (0.41–2.20).8961.33 (0.71–2.47).3851.23 (0.61–2.49).579
Time to debridement (>7 days)a0.96 (0.54–1.72).8991.60 (1.00–2.54)a.0501.70 (1.05–2.75).0331.33 (0.80–2.20)0.281
Exchange of polyethylene0.56 (0.31–1.02).0590.75 (0.46–1.21).2340.45 (0.26–0.77).0330.44 (0.26–0.76).003
Need for ≥2 debridements1.16 (0.57–2.36).6832.26 (1.63–4.36)<.0012.45 (1.45–4.15).0010.60 (0.26–1.40).206
Antimicrobial therapy‡
 Β-lactams (without rifampin)1.41 (0.88–2.27).1550.62 (0.37–1.03).0610.48 (0.28–0.84).010
 β-lactams + rifampin0.89 (0.47–1.70).7240.42 (0.18–0.98).0250.34 (0.12–0.96).041
 Quinolones + rifampin0.19 (0.03–1.36).0820.21 (0.03–1.54).1251.03 (0.45–2.40).940
 Glycopeptides without rifampin3.97 (2.08–7.58)<.0012.82 (1.43–5.53).0034.25 (1.32–13.7).015
 Duration of therapy >120 days0.54 (0.29–0.90).046

Abbreviations: aHR, adjusted hazard ratio; aOR, adjusted odds ratio; CI, confidence interval; HR, hazard ratio; OR, odds ratio.

aTime to debridement: time from onset of symptoms to the first surgical debridement. Initial models of multivariate analyses were built with variables with a P value < .10 in the univariate analysis and then selected with a stepwise backward process.

bEarly Failure: the initial multivariate model included age, rheumatoid arthritis, late post-surgical infections, Rx signs of infection, infection by S. pyogenes, and bacteremia.

cLate Failure: the initial multivariate model included sex, rheumatoid arthritis, immunosuppressant therapy, chronic renal disease, infection by S. viridians, time to debridement, need for ≥2 debridements, treatment with quinolones plus rifampin, and treatment with glycopeptides without rifampin.

dFailure After Therapy: the initial multivariate model included prosthesis location, late post-surgical infection, Rx signs of infection, exchange of removable components (i.e., polyethylene liner), treatment with beta-lactams (without rifampin), treatment with beta-lactams plus rifampin, and treatment with glycopeptides without rifampin.

e Non-hematogenous infection with symptoms beginning beyond 90 days after the prosthesis placement.

‡Treatments included in the analysis of Late Failure are those received during the first 30 days after debridement and are considered if they were administered for at least 15 days; treatments included in the analysis of Failure After Therapy are those received during the whole period of treatment, both orally and intravenously, and are considered if they were administered for at least 22 days.

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