Prosthetic joint infections: Treatment
- 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
Periprosthetic joint infection occurs in 1 to 2 percent of joint replacement surgeries and is a leading cause of arthroplasty failure [1-3]. Medical and surgical treatment of prosthetic joint infections (PJIs) will be reviewed here. Similar principles apply to infections associated with other implanted orthopedic devices, such as pins and rods .
Biofilms play an important role in the pathogenesis of PJIs. Organisms within biofilm become resistant to therapy; as a result, antimicrobial therapy is often unsuccessful unless the biofilm is physically disrupted or removed by surgical debridement. Biofilms also account for two other features of PJIs: the propensity of infection to become apparent weeks or months after surgery and the common observation that antimicrobial therapy results in a clinical response that is typically followed by a relapse within days or months if the infected prosthesis is retained. (See "Prosthetic joint infection: Epidemiology, clinical manifestations, and diagnosis", section on 'Biofilm'.)
The pathogenesis, clinical manifestations, and prevention of these infections are discussed separately. (See "Prosthetic joint infection: Epidemiology, clinical manifestations, and diagnosis" and "Epidemiology and prevention of prosthetic joint infections".)
TIMING OF INFECTION
Prosthetic joint infections are categorized according to the timing of symptom onset after implantation: early onset (<3 months after surgery), delayed onset (from 3 to 12 months after surgery), and late onset (>12 months after surgery). These infections have the following characteristics :
●Early-onset infections are usually acquired during implantation and are often due to virulent organisms, such as Staphylococcus aureus, gram-negative bacilli, anaerobic organisms, or mixed infections [1,4].
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- TIMING OF INFECTION
- CLINICAL APPROACH
- Resection arthroplasty with reimplantation
- - Two stage
- - One stage
- Debridement and retention of prosthesis
- Permanent resection arthroplasty
- CHOICE OF ANTIBIOTIC THERAPY
- Empiric antibiotic therapy
- Pathogen-specific antibiotic therapy
- - Staphylococci
- - Streptococci (beta-hemolytic)
- - Enterococci
- - Gram-negative bacilli
- - Anaerobes
- - Mycobacterium tuberculosis
- - Fungi
- - Culture negative
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS