Epidemiology and prevention of prosthetic joint infections
- Elie Berbari, MD, FIDSA
Elie Berbari, MD, FIDSA
- Professor of Medicine
- Mayo Clinic College of Medicine
- Larry M Baddour, MD, FIDSA
Larry M Baddour, MD, FIDSA
- Professor of Medicine
- Mayo Clinic College of Medicine
Prosthetic joint infection (PJI) is one of the leading causes of arthroplasty failure. Treatment of these infections requires multiple surgical interventions and prolonged antibiotic therapy and is associated with a failure rate in upwards of 10 to 20 percent of cases. Given the difficulty in treating prosthetic joint infections, prevention of infection is clearly desirable.
The issues relating to the prevention of PJIs will be reviewed here; guidelines addressing these issues include the National Surgical Infection Prevention Project [1,2], guidelines from the Medical Letter (table 1) , guidelines from the American Society of Health-System Pharmacists (ASHP) , and an Advisory Statement from the American Academy of Orthopaedic Surgeons .
The clinical manifestations, diagnosis, and treatment of these infections are discussed separately. (See "Clinical manifestations and diagnosis of prosthetic joint infections" and "Treatment of prosthetic joint infections".)
Infection rates for hip and knee replacements, the most common joint arthroplasties, are typically less than 2 percent [6,7]. The risk of prosthetic joint infection is greater for knee arthroplasty than hip arthroplasty. Risk factors for prosthetic joint infection include [8-11]:
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- PREVENTION OF INFECTION
- Prior to joint replacement
- - S. aureus decolonization
- - Other preventive measures
- During joint replacement
- - Antimicrobial prophylaxis
- - Local antibiotic delivery
- Following joint replacement
- - Dental procedures
- - Urologic procedures
- - Gastrointestinal procedures
- SUMMARY AND RECOMMENDATIONS