Treatment 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
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 "Clinical manifestations and diagnosis of prosthetic joint infections", section on 'Biofilm'.)
The pathogenesis, clinical manifestations, and prevention of these infections are discussed separately. (See "Clinical manifestations and diagnosis of prosthetic joint infections" 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