Abstract：
BACKGROUND: Periprosthetic joint infection (PJI) is a devastating complication in hip and knee joint arthroplasty. The \"Joint-Specific Bone Involvement, Antimicrobial Options, Coverage of the Soft Tissues, and Host Status (JS-BACH)\" classification system was developed in 2021 to stratify the complexity of PJI, and more importantly, to act as a tool to guide referrals to specialist centers. The \"JS-BACH\" classification has not been validated in an external cohort. This study aimed to do so using a large prospective cohort from Australia and New Zealand.
METHODS: We applied the JS-BACH classification to the Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) cohort. This prospective study of newly diagnosed PJI collected 2-year outcome data from 653 participants enrolled in 27 hospitals. The definition of PJI treatment failure at 24 months was any of the following: death, clinical or microbiological signs of infection, destination prosthesis removed, or ongoing antibiotic use. Individual cases were classified as per JS-BACH into \"1: uncomplicated\" (n = 268), \"2: complex\" (n = 330), and \"3: limited options\" (n = 55). This cohort was similar to the original JS-BACH population in terms of baseline characteristics. However, there was a difference in complexity, with more debridement, antibiotics, and implant retention procedures, fewer revision procedures, and a higher proportion of uncomplicated patients in the PIANO cohort.
RESULTS: The risk of treatment failure correlated strongly with the JS-BACH category, with odds ratios (95% confidence interval) for category 2 versus 1 of 1.75 (1.24 to 2.47) and for category 3 versus 1 of 7.12 (3.42 to 16.02).
CONCLUSIONS: Despite the PIANO study population being less complicated than the original derivation cohort, the JS-BACH classification showed a clear association with treatment failure in this large external cohort.
METHODS: We applied the JS-BACH classification to the Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) cohort. This prospective study of newly diagnosed PJI collected 2-year outcome data from 653 participants enrolled in 27 hospitals. The definition of PJI treatment failure at 24 months was any of the following: death, clinical or microbiological signs of infection, destination prosthesis removed, or ongoing antibiotic use. Individual cases were classified as per JS-BACH into \"1: uncomplicated\" (n = 268), \"2: complex\" (n = 330), and \"3: limited options\" (n = 55). This cohort was similar to the original JS-BACH population in terms of baseline characteristics. However, there was a difference in complexity, with more debridement, antibiotics, and implant retention procedures, fewer revision procedures, and a higher proportion of uncomplicated patients in the PIANO cohort.
RESULTS: The risk of treatment failure correlated strongly with the JS-BACH category, with odds ratios (95% confidence interval) for category 2 versus 1 of 1.75 (1.24 to 2.47) and for category 3 versus 1 of 7.12 (3.42 to 16.02).
CONCLUSIONS: Despite the PIANO study population being less complicated than the original derivation cohort, the JS-BACH classification showed a clear association with treatment failure in this large external cohort.
摘要：
背景：假体周围感染（PJI）是髋关节和膝关节置换术中的破坏性并发症。“JSBACH”分类系统于2021年开发，以对PJI的复杂性进行分层，更重要的是,作为指导转介专科中心的工具。“JSBACH”分类尚未在外部队列中验证。这项研究旨在使用来自澳大利亚和新西兰的大型前瞻性队列来做到这一点。
方法：我们将JS-BACH分类应用于澳大利亚和新西兰的假肢关节感染观察（PIANO）队列。这项新诊断的PJI的前瞻性研究收集了27家医院的653名参与者的2年结局数据。24个月时PJI治疗失败的定义是以下任何一种：死亡，临床或微生物感染的迹象，移除目的地假体,或持续使用抗生素。根据JS-BACH将个别病例分类为“1-不复杂”(n=268)，“2-复杂”(n=330)，和“3-有限选项”（n=55）。该队列在基线特征方面与原始JS-BACH群体相似。然而,复杂性有所不同，有更多的DAIR（清创术，抗生素,植入物保留)程序，更少的修订程序，在PIANO队列中，无并发症患者的比例更高。
结果：治疗失败的风险与JS-BACH类别密切相关，2类与1类的比值比（95%CI[置信区间]）为1.75（1.24至2.47），3类与1类的比值比为7.12（3.42至16.02）。
结论：尽管PIANO研究人群没有原始推导队列复杂，在这一大型外部队列中,JS-BACH分类与治疗失败有明显关联.
方法：我们将JS-BACH分类应用于澳大利亚和新西兰的假肢关节感染观察（PIANO）队列。这项新诊断的PJI的前瞻性研究收集了27家医院的653名参与者的2年结局数据。24个月时PJI治疗失败的定义是以下任何一种：死亡，临床或微生物感染的迹象，移除目的地假体,或持续使用抗生素。根据JS-BACH将个别病例分类为“1-不复杂”(n=268)，“2-复杂”(n=330)，和“3-有限选项”（n=55）。该队列在基线特征方面与原始JS-BACH群体相似。然而,复杂性有所不同，有更多的DAIR（清创术，抗生素,植入物保留)程序，更少的修订程序，在PIANO队列中，无并发症患者的比例更高。
结果：治疗失败的风险与JS-BACH类别密切相关，2类与1类的比值比（95%CI[置信区间]）为1.75（1.24至2.47），3类与1类的比值比为7.12（3.42至16.02）。
结论：尽管PIANO研究人群没有原始推导队列复杂，在这一大型外部队列中,JS-BACH分类与治疗失败有明显关联.
