Univariate and Multivariate Analysis of Parameters Predicting Early Failure, Late Failure and Failure After Therapy
. | Early Failure (n = 444, 55 Failures)b . | Late Failure (n = 389, 71 Failures)c . | Failure After Therapy (N = 318, 61 Failures)d . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
OR (95% CI) . | P . | aOR (95%CI) . | P . | HR (95%CI) . | P . | aHR (95% CI) . | P . | HR (95%CI) . | P . | aHR (95% CI) . | P . | |
Sex (female) | 1.19 (0.68–2.10) | .540 | 0.50 (0.31–0.81) | .004 | 0.51 (0.30–0.85) | .009 | 1.16 (0.69–1.92) | .572 | ||||
Age (per year) | 1.03 (0.99–1.01) | .076 | 1.04 (1.00–1.07) | .027 | 1.00 (0.98–1.02) | .995 | 0.99 (0.97–1.01) | .348 | ||||
Rheumatoid arthritis | 2.98 (1.35–6.56) | .007 | 3.33 (1.40–7.93) | .007 | 2.95 (1.55–5.62) | .004 | - | - | 1.19 (0.37–3.81) | .772 | ||
Immunosuppressive therapy | 1.49 (0.66–3.66) | .343 | 2.76 (1.56–4.89) | .002 | 2.64 (1.46–4.79) | .001 | 1.51 (0.65–3.51) | .363 | ||||
Renal chronic disease | 1.67 (0.73–3.81) | .223 | 1.99 (1.05–3.79) | .053 | - | - | 1.17 (0.47–2.91) | .746 | ||||
Prosthesis location (knee) | 1.04 (0.86–1.26) | .677 | 0.98 (0.83–1.14) | .753 | 1.18 (0.98–1.41) | .073 | - | - | ||||
Revision prosthesis | 1.53 (0.83–2.81) | .173 | 1.78 (1.09–2.91) | .027 | 1.77 (1.07–2.93) | .027 | 1.56 (0.90–2.70) | .129 | ||||
Chronic post-surgical inf.e | 1.212 (0.97–1.23) | .091 | 1.41 (1.10–1.81) | .007 | 1.12 (0.92–1.37) | .256 | 1.47 (1.22–1.77) | <.001 | 2.24 (1.24–4.05) | .008 | ||
Sinus tract | 0.75 (0.31–1.84) | .529 | 1.05 (0.54–2.06) | .881 | 1.61 (0.84–3.11) | .175 | ||||||
Bacteremia | 2.17 (1.20–3.92) | .011 | 2.23 (1.80–4.20) | .014 | 1.24 (0.74–2.06) | .420 | 1.23 (0.70–2.19) | .478 | ||||
Rx signs of infection | 1.16 (0.98–1.39) | .091 | - | - | 0.77 (0.40–1.48) | .421 | 2.21 (1.14–4.30) | .025 | - | - | ||
Infection by S. pyogenes | 3.10 (1.41–6.85) | .005 | 3.31 (1.41–7.77) | .006 | 0.60 (0.19–1.92) | .357 | 1.11 (0.45–2.78) | .821 | ||||
Infection by virdidans streptococci | 0.71 (0.32–1.57) | .401 | 1.60 (0.94–2.70) | .094 | … | … | 1.01 (0.51–1.98) | .987 | ||||
Polymicrobial infection | 0.95 (0.41–2.20) | .896 | 1.33 (0.71–2.47) | .385 | 1.23 (0.61–2.49) | .579 | ||||||
Time to debridement (>7 days)a | 0.96 (0.54–1.72) | .899 | 1.60 (1.00–2.54)a | .050 | 1.70 (1.05–2.75) | .033 | 1.33 (0.80–2.20) | 0.281 | ||||
Exchange of polyethylene | 0.56 (0.31–1.02) | .059 | … | … | 0.75 (0.46–1.21) | .234 | 0.45 (0.26–0.77) | .033 | 0.44 (0.26–0.76) | .003 | ||
Need for ≥2 debridements | 1.16 (0.57–2.36) | .683 | 2.26 (1.63–4.36) | <.001 | 2.45 (1.45–4.15) | .001 | 0.60 (0.26–1.40) | .206 | ||||
Antimicrobial therapy‡ | ||||||||||||
Β-lactams (without rifampin) | … | … | 1.41 (0.88–2.27) | .155 | 0.62 (0.37–1.03) | .061 | 0.48 (0.28–0.84) | .010 | ||||
β-lactams + rifampin | … | … | 0.89 (0.47–1.70) | .724 | 0.42 (0.18–0.98) | .025 | 0.34 (0.12–0.96) | .041 | ||||
Quinolones + rifampin | … | … | 0.19 (0.03–1.36) | .082 | 0.21 (0.03–1.54) | .125 | 1.03 (0.45–2.40) | .940 | ||||
Glycopeptides without rifampin | … | … | 3.97 (2.08–7.58) | <.001 | 2.82 (1.43–5.53) | .003 | 4.25 (1.32–13.7) | .015 | … | … | ||
Duration of therapy >120 days | … | … | … | … | 0.54 (0.29–0.90) | .046 | … | … |
. | Early Failure (n = 444, 55 Failures)b . | Late Failure (n = 389, 71 Failures)c . | Failure After Therapy (N = 318, 61 Failures)d . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
OR (95% CI) . | P . | aOR (95%CI) . | P . | HR (95%CI) . | P . | aHR (95% CI) . | P . | HR (95%CI) . | P . | aHR (95% CI) . | P . | |
Sex (female) | 1.19 (0.68–2.10) | .540 | 0.50 (0.31–0.81) | .004 | 0.51 (0.30–0.85) | .009 | 1.16 (0.69–1.92) | .572 | ||||
Age (per year) | 1.03 (0.99–1.01) | .076 | 1.04 (1.00–1.07) | .027 | 1.00 (0.98–1.02) | .995 | 0.99 (0.97–1.01) | .348 | ||||
Rheumatoid arthritis | 2.98 (1.35–6.56) | .007 | 3.33 (1.40–7.93) | .007 | 2.95 (1.55–5.62) | .004 | - | - | 1.19 (0.37–3.81) | .772 | ||
Immunosuppressive therapy | 1.49 (0.66–3.66) | .343 | 2.76 (1.56–4.89) | .002 | 2.64 (1.46–4.79) | .001 | 1.51 (0.65–3.51) | .363 | ||||
Renal chronic disease | 1.67 (0.73–3.81) | .223 | 1.99 (1.05–3.79) | .053 | - | - | 1.17 (0.47–2.91) | .746 | ||||
Prosthesis location (knee) | 1.04 (0.86–1.26) | .677 | 0.98 (0.83–1.14) | .753 | 1.18 (0.98–1.41) | .073 | - | - | ||||
Revision prosthesis | 1.53 (0.83–2.81) | .173 | 1.78 (1.09–2.91) | .027 | 1.77 (1.07–2.93) | .027 | 1.56 (0.90–2.70) | .129 | ||||
Chronic post-surgical inf.e | 1.212 (0.97–1.23) | .091 | 1.41 (1.10–1.81) | .007 | 1.12 (0.92–1.37) | .256 | 1.47 (1.22–1.77) | <.001 | 2.24 (1.24–4.05) | .008 | ||
Sinus tract | 0.75 (0.31–1.84) | .529 | 1.05 (0.54–2.06) | .881 | 1.61 (0.84–3.11) | .175 | ||||||
Bacteremia | 2.17 (1.20–3.92) | .011 | 2.23 (1.80–4.20) | .014 | 1.24 (0.74–2.06) | .420 | 1.23 (0.70–2.19) | .478 | ||||
Rx signs of infection | 1.16 (0.98–1.39) | .091 | - | - | 0.77 (0.40–1.48) | .421 | 2.21 (1.14–4.30) | .025 | - | - | ||
Infection by S. pyogenes | 3.10 (1.41–6.85) | .005 | 3.31 (1.41–7.77) | .006 | 0.60 (0.19–1.92) | .357 | 1.11 (0.45–2.78) | .821 | ||||
Infection by virdidans streptococci | 0.71 (0.32–1.57) | .401 | 1.60 (0.94–2.70) | .094 | … | … | 1.01 (0.51–1.98) | .987 | ||||
Polymicrobial infection | 0.95 (0.41–2.20) | .896 | 1.33 (0.71–2.47) | .385 | 1.23 (0.61–2.49) | .579 | ||||||
Time to debridement (>7 days)a | 0.96 (0.54–1.72) | .899 | 1.60 (1.00–2.54)a | .050 | 1.70 (1.05–2.75) | .033 | 1.33 (0.80–2.20) | 0.281 | ||||
Exchange of polyethylene | 0.56 (0.31–1.02) | .059 | … | … | 0.75 (0.46–1.21) | .234 | 0.45 (0.26–0.77) | .033 | 0.44 (0.26–0.76) | .003 | ||
Need for ≥2 debridements | 1.16 (0.57–2.36) | .683 | 2.26 (1.63–4.36) | <.001 | 2.45 (1.45–4.15) | .001 | 0.60 (0.26–1.40) | .206 | ||||
Antimicrobial therapy‡ | ||||||||||||
Β-lactams (without rifampin) | … | … | 1.41 (0.88–2.27) | .155 | 0.62 (0.37–1.03) | .061 | 0.48 (0.28–0.84) | .010 | ||||
β-lactams + rifampin | … | … | 0.89 (0.47–1.70) | .724 | 0.42 (0.18–0.98) | .025 | 0.34 (0.12–0.96) | .041 | ||||
Quinolones + rifampin | … | … | 0.19 (0.03–1.36) | .082 | 0.21 (0.03–1.54) | .125 | 1.03 (0.45–2.40) | .940 | ||||
Glycopeptides without rifampin | … | … | 3.97 (2.08–7.58) | <.001 | 2.82 (1.43–5.53) | .003 | 4.25 (1.32–13.7) | .015 | … | … | ||
Duration of therapy >120 days | … | … | … | … | 0.54 (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.
Univariate and Multivariate Analysis of Parameters Predicting Early Failure, Late Failure and Failure After Therapy
. | Early Failure (n = 444, 55 Failures)b . | Late Failure (n = 389, 71 Failures)c . | Failure After Therapy (N = 318, 61 Failures)d . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
OR (95% CI) . | P . | aOR (95%CI) . | P . | HR (95%CI) . | P . | aHR (95% CI) . | P . | HR (95%CI) . | P . | aHR (95% CI) . | P . | |
Sex (female) | 1.19 (0.68–2.10) | .540 | 0.50 (0.31–0.81) | .004 | 0.51 (0.30–0.85) | .009 | 1.16 (0.69–1.92) | .572 | ||||
Age (per year) | 1.03 (0.99–1.01) | .076 | 1.04 (1.00–1.07) | .027 | 1.00 (0.98–1.02) | .995 | 0.99 (0.97–1.01) | .348 | ||||
Rheumatoid arthritis | 2.98 (1.35–6.56) | .007 | 3.33 (1.40–7.93) | .007 | 2.95 (1.55–5.62) | .004 | - | - | 1.19 (0.37–3.81) | .772 | ||
Immunosuppressive therapy | 1.49 (0.66–3.66) | .343 | 2.76 (1.56–4.89) | .002 | 2.64 (1.46–4.79) | .001 | 1.51 (0.65–3.51) | .363 | ||||
Renal chronic disease | 1.67 (0.73–3.81) | .223 | 1.99 (1.05–3.79) | .053 | - | - | 1.17 (0.47–2.91) | .746 | ||||
Prosthesis location (knee) | 1.04 (0.86–1.26) | .677 | 0.98 (0.83–1.14) | .753 | 1.18 (0.98–1.41) | .073 | - | - | ||||
Revision prosthesis | 1.53 (0.83–2.81) | .173 | 1.78 (1.09–2.91) | .027 | 1.77 (1.07–2.93) | .027 | 1.56 (0.90–2.70) | .129 | ||||
Chronic post-surgical inf.e | 1.212 (0.97–1.23) | .091 | 1.41 (1.10–1.81) | .007 | 1.12 (0.92–1.37) | .256 | 1.47 (1.22–1.77) | <.001 | 2.24 (1.24–4.05) | .008 | ||
Sinus tract | 0.75 (0.31–1.84) | .529 | 1.05 (0.54–2.06) | .881 | 1.61 (0.84–3.11) | .175 | ||||||
Bacteremia | 2.17 (1.20–3.92) | .011 | 2.23 (1.80–4.20) | .014 | 1.24 (0.74–2.06) | .420 | 1.23 (0.70–2.19) | .478 | ||||
Rx signs of infection | 1.16 (0.98–1.39) | .091 | - | - | 0.77 (0.40–1.48) | .421 | 2.21 (1.14–4.30) | .025 | - | - | ||
Infection by S. pyogenes | 3.10 (1.41–6.85) | .005 | 3.31 (1.41–7.77) | .006 | 0.60 (0.19–1.92) | .357 | 1.11 (0.45–2.78) | .821 | ||||
Infection by virdidans streptococci | 0.71 (0.32–1.57) | .401 | 1.60 (0.94–2.70) | .094 | … | … | 1.01 (0.51–1.98) | .987 | ||||
Polymicrobial infection | 0.95 (0.41–2.20) | .896 | 1.33 (0.71–2.47) | .385 | 1.23 (0.61–2.49) | .579 | ||||||
Time to debridement (>7 days)a | 0.96 (0.54–1.72) | .899 | 1.60 (1.00–2.54)a | .050 | 1.70 (1.05–2.75) | .033 | 1.33 (0.80–2.20) | 0.281 | ||||
Exchange of polyethylene | 0.56 (0.31–1.02) | .059 | … | … | 0.75 (0.46–1.21) | .234 | 0.45 (0.26–0.77) | .033 | 0.44 (0.26–0.76) | .003 | ||
Need for ≥2 debridements | 1.16 (0.57–2.36) | .683 | 2.26 (1.63–4.36) | <.001 | 2.45 (1.45–4.15) | .001 | 0.60 (0.26–1.40) | .206 | ||||
Antimicrobial therapy‡ | ||||||||||||
Β-lactams (without rifampin) | … | … | 1.41 (0.88–2.27) | .155 | 0.62 (0.37–1.03) | .061 | 0.48 (0.28–0.84) | .010 | ||||
β-lactams + rifampin | … | … | 0.89 (0.47–1.70) | .724 | 0.42 (0.18–0.98) | .025 | 0.34 (0.12–0.96) | .041 | ||||
Quinolones + rifampin | … | … | 0.19 (0.03–1.36) | .082 | 0.21 (0.03–1.54) | .125 | 1.03 (0.45–2.40) | .940 | ||||
Glycopeptides without rifampin | … | … | 3.97 (2.08–7.58) | <.001 | 2.82 (1.43–5.53) | .003 | 4.25 (1.32–13.7) | .015 | … | … | ||
Duration of therapy >120 days | … | … | … | … | 0.54 (0.29–0.90) | .046 | … | … |
. | Early Failure (n = 444, 55 Failures)b . | Late Failure (n = 389, 71 Failures)c . | Failure After Therapy (N = 318, 61 Failures)d . | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
OR (95% CI) . | P . | aOR (95%CI) . | P . | HR (95%CI) . | P . | aHR (95% CI) . | P . | HR (95%CI) . | P . | aHR (95% CI) . | P . | |
Sex (female) | 1.19 (0.68–2.10) | .540 | 0.50 (0.31–0.81) | .004 | 0.51 (0.30–0.85) | .009 | 1.16 (0.69–1.92) | .572 | ||||
Age (per year) | 1.03 (0.99–1.01) | .076 | 1.04 (1.00–1.07) | .027 | 1.00 (0.98–1.02) | .995 | 0.99 (0.97–1.01) | .348 | ||||
Rheumatoid arthritis | 2.98 (1.35–6.56) | .007 | 3.33 (1.40–7.93) | .007 | 2.95 (1.55–5.62) | .004 | - | - | 1.19 (0.37–3.81) | .772 | ||
Immunosuppressive therapy | 1.49 (0.66–3.66) | .343 | 2.76 (1.56–4.89) | .002 | 2.64 (1.46–4.79) | .001 | 1.51 (0.65–3.51) | .363 | ||||
Renal chronic disease | 1.67 (0.73–3.81) | .223 | 1.99 (1.05–3.79) | .053 | - | - | 1.17 (0.47–2.91) | .746 | ||||
Prosthesis location (knee) | 1.04 (0.86–1.26) | .677 | 0.98 (0.83–1.14) | .753 | 1.18 (0.98–1.41) | .073 | - | - | ||||
Revision prosthesis | 1.53 (0.83–2.81) | .173 | 1.78 (1.09–2.91) | .027 | 1.77 (1.07–2.93) | .027 | 1.56 (0.90–2.70) | .129 | ||||
Chronic post-surgical inf.e | 1.212 (0.97–1.23) | .091 | 1.41 (1.10–1.81) | .007 | 1.12 (0.92–1.37) | .256 | 1.47 (1.22–1.77) | <.001 | 2.24 (1.24–4.05) | .008 | ||
Sinus tract | 0.75 (0.31–1.84) | .529 | 1.05 (0.54–2.06) | .881 | 1.61 (0.84–3.11) | .175 | ||||||
Bacteremia | 2.17 (1.20–3.92) | .011 | 2.23 (1.80–4.20) | .014 | 1.24 (0.74–2.06) | .420 | 1.23 (0.70–2.19) | .478 | ||||
Rx signs of infection | 1.16 (0.98–1.39) | .091 | - | - | 0.77 (0.40–1.48) | .421 | 2.21 (1.14–4.30) | .025 | - | - | ||
Infection by S. pyogenes | 3.10 (1.41–6.85) | .005 | 3.31 (1.41–7.77) | .006 | 0.60 (0.19–1.92) | .357 | 1.11 (0.45–2.78) | .821 | ||||
Infection by virdidans streptococci | 0.71 (0.32–1.57) | .401 | 1.60 (0.94–2.70) | .094 | … | … | 1.01 (0.51–1.98) | .987 | ||||
Polymicrobial infection | 0.95 (0.41–2.20) | .896 | 1.33 (0.71–2.47) | .385 | 1.23 (0.61–2.49) | .579 | ||||||
Time to debridement (>7 days)a | 0.96 (0.54–1.72) | .899 | 1.60 (1.00–2.54)a | .050 | 1.70 (1.05–2.75) | .033 | 1.33 (0.80–2.20) | 0.281 | ||||
Exchange of polyethylene | 0.56 (0.31–1.02) | .059 | … | … | 0.75 (0.46–1.21) | .234 | 0.45 (0.26–0.77) | .033 | 0.44 (0.26–0.76) | .003 | ||
Need for ≥2 debridements | 1.16 (0.57–2.36) | .683 | 2.26 (1.63–4.36) | <.001 | 2.45 (1.45–4.15) | .001 | 0.60 (0.26–1.40) | .206 | ||||
Antimicrobial therapy‡ | ||||||||||||
Β-lactams (without rifampin) | … | … | 1.41 (0.88–2.27) | .155 | 0.62 (0.37–1.03) | .061 | 0.48 (0.28–0.84) | .010 | ||||
β-lactams + rifampin | … | … | 0.89 (0.47–1.70) | .724 | 0.42 (0.18–0.98) | .025 | 0.34 (0.12–0.96) | .041 | ||||
Quinolones + rifampin | … | … | 0.19 (0.03–1.36) | .082 | 0.21 (0.03–1.54) | .125 | 1.03 (0.45–2.40) | .940 | ||||
Glycopeptides without rifampin | … | … | 3.97 (2.08–7.58) | <.001 | 2.82 (1.43–5.53) | .003 | 4.25 (1.32–13.7) | .015 | … | … | ||
Duration of therapy >120 days | … | … | … | … | 0.54 (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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