Prosthetic joint infection - Revision history

Aidan: /* Antimicrobial Therapy */

2025-09-30T16:15:54Z

Antimicrobial Therapy

← Older revision		Revision as of 16:15, 30 September 2025
Line 192:		Line 192:
	\|4-6 weeks		\|4-6 weeks
	\|12 weeks<sup>†</sup>		\|12 weeks<sup>†</sup>
	\|		\|no
	\|±		\|±
	\|-		\|-
	\|resection ± reimplantation		\|resection ± reimplantation (2-stage exchange)
	\|—		\|—
	\|—		\|—
	\|4-6 weeks		\|4-6 weeks
			\|—
	\|		\|
	\|		\|no
	\|
	\|-		\|-
	\| rowspan="2" \|1-stage exchange		\| rowspan="2" \|1-stage exchange
Line 215:		Line 215:
	\|4-6 weeks		\|4-6 weeks
	\|3 months		\|3 months
	\|		\|no
	\|±		\|±
	\|-		\|-
Line 222:		Line 222:
	\|—		\|—
	\|24-48 hours		\|24-48 hours
	\|		\|—
	\|		\|no
	\|		\|no
	\|-		\|-
	\|amputation without source control		\|amputation without source control
Line 230:		Line 230:
	\|—		\|—
	\|4-6 weeks		\|4-6 weeks
	\|		\|—
	\|		\|no
	\|		\|no
	\|}		\|}

Aidan at 21:50, 25 December 2024

2024-12-25T21:50:23Z

← Older revision		Revision as of 21:50, 25 December 2024
Line 148:		Line 148:
	*Options include:		*Options include:
	**Debridement and implant retention (DAIR), preferred if well-fixed prosthesis, no sinus tract, susceptible to oral antibiotics, joint age <30 days, and symptoms <3 weeks		**Debridement and implant retention (DAIR), preferred if well-fixed prosthesis, no sinus tract, susceptible to oral antibiotics, joint age <30 days, and symptoms <3 weeks
			***Need for further revision is 20-30% and is lowest is done within 4 weeks from index arthroplasty[[CiteRef::kristensen2024ou]]
	**One-stage replacement		**One-stage replacement
	**Two-stage replacement, where the prosthesis is removed and replaced with a cement spacer, the infection is treated, and then a new prosthesis is placed		**Two-stage replacement, where the prosthesis is removed and replaced with a cement spacer, the infection is treated, and then a new prosthesis is placed

Aidan at 17:18, 27 September 2024

2024-09-27T17:18:48Z

← Older revision		Revision as of 17:18, 27 September 2024
Line 235:		Line 235:

	<sup></sup> IV therapy includes highly bioavailable oral therapy		<sup></sup> IV therapy includes highly bioavailable oral therapy
			*<sup>†</sup> per DAPITO trial[[CiteRef::bernard2021an]]
	*<sup>†</sup> per DAPITO trial<ref>Bernard L, Arvieux C, Brunschweiler B, Touchais S, Ansart S, Bru JP, Oziol E, Boeri C, Gras G, Druon J, Rosset P, Senneville E, Bentayeb H, Bouhour D, Le Moal G, Michon J, Aumaître H, Forestier E, Laffosse JM, Begué T, Chirouze C, Dauchy FA, Devaud E, Martha B, Burgot D, Boutoille D, Stindel E, Dinh A, Bemer P, Giraudeau B, Issartel B, Caille A. Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection. ''N Engl J Med''. 2021 May 27;384(21):1991-2001. doi: [https://doi.org/10.1056/NEJMoa2020198 10.1056/NEJMoa2020198]. PMID: [https://pubmed.ncbi.nlm.nih.gov/34042388/ 34042388].</ref>

	===Intravenous and Highly Bioavailable Oral Therapy===		===Intravenous and Highly Bioavailable Oral Therapy===
Line 344:		Line 344:

	* Mostly 12 weeks of antibiotics (24 weeks for staphylococcal knee infections), as in above table		* Mostly 12 weeks of antibiotics (24 weeks for staphylococcal knee infections), as in above table
			* DAPITO trial showed inferiority of 6 weeks compared to 12 weeks after DAIR[[CiteRef::bernard2021an]]
	* DAPITO trial showed inferiority of 6 weeks compared to 12 weeks after DAIR<ref>Bernard L, Arvieux C, Brunschweiler B, Touchais S, Ansart S, Bru JP, Oziol E, Boeri C, Gras G, Druon J, Rosset P, Senneville E, Bentayeb H, Bouhour D, Le Moal G, Michon J, Aumaître H, Forestier E, Laffosse JM, Begué T, Chirouze C, Dauchy FA, Devaud E, Martha B, Burgot D, Boutoille D, Stindel E, Dinh A, Bemer P, Giraudeau B, Issartel B, Caille A. Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection. N Engl J Med. 2021 May 27;384(21):1991-2001. doi: [https://doi.org/10.1056/NEJMoa2020198 10.1056/NEJMoa2020198]. PMID: 34042388.</ref>

	==== Chronic Suppressive Therapy ====		==== Chronic Suppressive Therapy ====

Aidan at 19:17, 3 February 2024

2024-02-03T19:17:20Z

← Older revision		Revision as of 19:17, 3 February 2024
Line 235:		Line 235:

	<sup></sup> IV therapy includes highly bioavailable oral therapy		<sup></sup> IV therapy includes highly bioavailable oral therapy
	*<sup>†</sup> per DAPITO trial<ref>Bernard L, Arvieux C, Brunschweiler B, Touchais S, Ansart S, Bru JP, Oziol E, Boeri C, Gras G, Druon J, Rosset P, Senneville E, Bentayeb H, Bouhour D, Le Moal G, Michon J, Aumaître H, Forestier E, Laffosse JM, Begué T, Chirouze C, Dauchy FA, Devaud E, Martha B, Burgot D, Boutoille D, Stindel E, Dinh A, Bemer P, Giraudeau B, Issartel B, Caille A. Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection. N Engl J Med. 2021 May 27;384(21):1991-2001. doi: 10.1056/NEJMoa2020198. PMID: 34042388.</ref>		*<sup>†</sup> per DAPITO trial<ref>Bernard L, Arvieux C, Brunschweiler B, Touchais S, Ansart S, Bru JP, Oziol E, Boeri C, Gras G, Druon J, Rosset P, Senneville E, Bentayeb H, Bouhour D, Le Moal G, Michon J, Aumaître H, Forestier E, Laffosse JM, Begué T, Chirouze C, Dauchy FA, Devaud E, Martha B, Burgot D, Boutoille D, Stindel E, Dinh A, Bemer P, Giraudeau B, Issartel B, Caille A. Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection. ''N Engl J Med''. 2021 May 27;384(21):1991-2001. doi: [https://doi.org/10.1056/NEJMoa2020198 10.1056/NEJMoa2020198]. PMID: [https://pubmed.ncbi.nlm.nih.gov/34042388/ 34042388].</ref>

	===Intravenous and Highly Bioavailable Oral Therapy===		===Intravenous and Highly Bioavailable Oral Therapy===

Aidan: /* Management after DAIR */

2023-02-06T20:57:36Z

Management after DAIR

← Older revision		Revision as of 20:57, 6 February 2023
Line 344:		Line 344:

	* Mostly 12 weeks of antibiotics (24 weeks for staphylococcal knee infections), as in above table		* Mostly 12 weeks of antibiotics (24 weeks for staphylococcal knee infections), as in above table
	* DAPITO trial showed inferiority of 6 weeks compared to 12 weeks after DAIR<ref>Bernard L, Arvieux C, Brunschweiler B, Touchais S, Ansart S, Bru JP, Oziol E, Boeri C, Gras G, Druon J, Rosset P, Senneville E, Bentayeb H, Bouhour D, Le Moal G, Michon J, Aumaître H, Forestier E, Laffosse JM, Begué T, Chirouze C, Dauchy FA, Devaud E, Martha B, Burgot D, Boutoille D, Stindel E, Dinh A, Bemer P, Giraudeau B, Issartel B, Caille A. Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection. N Engl J Med. 2021 May 27;384(21):1991-2001. doi: 10.1056/NEJMoa2020198. PMID: 34042388.</ref>		* DAPITO trial showed inferiority of 6 weeks compared to 12 weeks after DAIR<ref>Bernard L, Arvieux C, Brunschweiler B, Touchais S, Ansart S, Bru JP, Oziol E, Boeri C, Gras G, Druon J, Rosset P, Senneville E, Bentayeb H, Bouhour D, Le Moal G, Michon J, Aumaître H, Forestier E, Laffosse JM, Begué T, Chirouze C, Dauchy FA, Devaud E, Martha B, Burgot D, Boutoille D, Stindel E, Dinh A, Bemer P, Giraudeau B, Issartel B, Caille A. Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection. N Engl J Med. 2021 May 27;384(21):1991-2001. doi: [https://doi.org/10.1056/NEJMoa2020198 10.1056/NEJMoa2020198]. PMID: 34042388.</ref>

	==== Chronic Suppressive Therapy ====		==== Chronic Suppressive Therapy ====

Aidan at 21:42, 6 November 2022

2022-11-06T21:42:51Z

← Older revision		Revision as of 21:42, 6 November 2022
Line 240:		Line 240:

	====Choice of Antimicrobial====		====Choice of Antimicrobial====

			* Increasing evidence suggests that regimens of [[fluoroquinolone]] plus [[rifampin]] has the lowest risk of recurrence, and should likely be the preferred regimen in staphylococcal infections with susceptible organisms

	{\| class="wikitable"		{\| class="wikitable"
			\|+IDSA guideline-based antimicrobial recommendations
	!Species		!Species
	!Preferred Antimicrobials		!Preferred Antimicrobials

Aidan: /* Management after DAIR */

2022-11-04T09:38:54Z

Management after DAIR

← Older revision		Revision as of 09:38, 4 November 2022
Line 161:		Line 161:
	!Species		!Species
	!Location		!Location
	!Duration IV		!Duration IV<sup>*</sup>
	!Total Duration		!Total Duration
	!Adjunctive Rifampin		!Adjunctive Rifampin
Line 190:		Line 190:
	\|—		\|—
	\|4-6 weeks		\|4-6 weeks
			\|12 weeks<sup>†</sup>
	\|
	\|		\|
	\|±		\|±
Line 234:		Line 234:
	\|}		\|}

	*IV therapy includes highly bioavailable oral therapy		<sup></sup> IV therapy includes highly bioavailable oral therapy
			*<sup>†</sup> per DAPITO trial<ref>Bernard L, Arvieux C, Brunschweiler B, Touchais S, Ansart S, Bru JP, Oziol E, Boeri C, Gras G, Druon J, Rosset P, Senneville E, Bentayeb H, Bouhour D, Le Moal G, Michon J, Aumaître H, Forestier E, Laffosse JM, Begué T, Chirouze C, Dauchy FA, Devaud E, Martha B, Burgot D, Boutoille D, Stindel E, Dinh A, Bemer P, Giraudeau B, Issartel B, Caille A. Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection. N Engl J Med. 2021 May 27;384(21):1991-2001. doi: 10.1056/NEJMoa2020198. PMID: 34042388.</ref>

	===Intravenous and Highly Bioavailable Oral Therapy===		===Intravenous and Highly Bioavailable Oral Therapy===
Line 339:		Line 340:

	* Mostly 12 weeks of antibiotics (24 weeks for staphylococcal knee infections), as in above table		* Mostly 12 weeks of antibiotics (24 weeks for staphylococcal knee infections), as in above table
			* DAPITO trial showed inferiority of 6 weeks compared to 12 weeks after DAIR<ref>Bernard L, Arvieux C, Brunschweiler B, Touchais S, Ansart S, Bru JP, Oziol E, Boeri C, Gras G, Druon J, Rosset P, Senneville E, Bentayeb H, Bouhour D, Le Moal G, Michon J, Aumaître H, Forestier E, Laffosse JM, Begué T, Chirouze C, Dauchy FA, Devaud E, Martha B, Burgot D, Boutoille D, Stindel E, Dinh A, Bemer P, Giraudeau B, Issartel B, Caille A. Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection. N Engl J Med. 2021 May 27;384(21):1991-2001. doi: 10.1056/NEJMoa2020198. PMID: 34042388.</ref>

	==== Chronic Suppressive Therapy ====		==== Chronic Suppressive Therapy ====

Aidan: /* Chronic Suppressive Therapy */

2022-10-04T01:56:16Z

Chronic Suppressive Therapy

← Older revision		Revision as of 01:56, 4 October 2022
Line 143:		Line 143:
	==Management==		==Management==

	===Surgical ~~Therapy~~===		===Surgical Management===

	*Ultimately the decision of whether and how to treat surgically rests with the orthopedic surgeon		*Ultimately the decision of whether and how to treat surgically rests with the orthopedic surgeon
Line 336:		Line 336:
	* Alternatively , can potentially use [[rifabutin]] 300 mg PO daily[[CiteRef::doub2020ri]]		* Alternatively , can potentially use [[rifabutin]] 300 mg PO daily[[CiteRef::doub2020ri]]

			=== Management after DAIR ===
⚫	===Chronic Suppressive Therapy===

			* Mostly 12 weeks of antibiotics (24 weeks for staphylococcal knee infections), as in above table

		⚫	==== Chronic Suppressive Therapy ====
	*Sometimes considered after debridement and implant retention		*Sometimes considered after debridement and implant retention
	*Duration unclear; 3-12 months or indefinite		*Duration unclear; 3-12 months or indefinite
Line 389:		Line 392:
	[[Doxycycline]] 100 mg PO bid		[[Doxycycline]] 100 mg PO bid
	\|}		\|}

			=== Management With One-Stage Replacement ===

			* Duration 6 to 12 weeks of antibiotics

			=== Management With Two-Stage Replacement ===

			* Initially 6 to 12 weeks of antibiotics, followed by a 2+ week antibiotic holiday, then reimplantation

	===Intra-Articular Infusion===		===Intra-Articular Infusion===

Aidan: /* Chronic Suppressive Therapy */

2022-10-04T01:52:49Z

Chronic Suppressive Therapy

← Older revision		Revision as of 01:52, 4 October 2022
Line 338:		Line 338:
	===Chronic Suppressive Therapy===		===Chronic Suppressive Therapy===

			*Sometimes considered after debridement and implant retention
	*Duration unclear; 3-12 months or indefinite		*Duration unclear; 3-12 months or indefinite
	*In people in whom there is recurrence, it tends to recur within 4 months of discontinuing suppressive therapy		*In people in whom there is recurrence, it tends to recur within 4 months of discontinuing suppressive therapy
	*~~Indefinite~~ ~~courses~~ ~~are~~ recommended where there is a high risk of recurrence or where the consequences of recurrence would be devastating		*Chronic suppression is recommended where there is a high risk of recurrence or where the consequences of recurrence would be devastating
			**High-risk bacteria like [[Staphylococcus aureus]] or [[Multidrug-resistant Gram-negative bacteria]]
	**Patient-level risk factors include male sex and overall burden of comorbidities, but also specifically [[obesity]], [[diabetes]], rheumatologic diseases (particularly [[rheumatoid arthritis]]), and heart disease (particularly [[heart failure]])<ref>Lenguerrand E, Whitehouse MR, Beswick AD, Kunutsor SK, Foguet P, Porter M, Blom AW; National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales. Lancet Infect Dis. 2019 Jun;19(6):589-600. doi: 10.1016/S1473-3099(18)30755-2. Epub 2019 Apr 17. PMID: 31005559; PMCID: PMC6531378.</ref>
			**Limited life expectancy
			**Prior treatment failure
			**Poor candidate for future surgeries
			*Reassess the suppressive therapy every 6 to 12 months

	{\| class="wikitable"		{\| class="wikitable"

Aidan: /* Chronic Suppressive Therapy */

2022-09-30T14:35:31Z

Chronic Suppressive Therapy

← Older revision		Revision as of 14:35, 30 September 2022
Line 341:		Line 341:
	*In people in whom there is recurrence, it tends to recur within 4 months of discontinuing suppressive therapy		*In people in whom there is recurrence, it tends to recur within 4 months of discontinuing suppressive therapy
	*Indefinite courses are recommended where there is a high risk of recurrence or where the consequences of recurrence would be devastating		*Indefinite courses are recommended where there is a high risk of recurrence or where the consequences of recurrence would be devastating
	**Patient-level risk factors include male sex and overall burden of comorbidities, but also specifically [[obesity]], [[diabetes]], rheumatologic diseases (particularly [[rheumatoid arthritis]]), and heart disease (particularly [[heart failure]])<ref>Lenguerrand E, Whitehouse MR, Beswick AD, Kunutsor SK, Foguet P, Porter M, Blom AW; National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales. Lancet Infect Dis. 2019 Jun;19(6):589-600. doi: 10.1016/S1473-3099(18)30755-2. Epub 2019 Apr 17. PMID: 31005559; PMCID: PMC6531378.</ref><ref>Ren X, Ling L, Qi L, Liu Z, Zhang W, Yang Z, Wang W, Tu C, Li Z. Patients' risk factors for periprosthetic joint infection in primary total hip arthroplasty: a meta-analysis of 40 studies. BMC Musculoskelet Disord. 2021 Sep 12;22(1):776. doi: 10.1186/s12891-021-04647-1. PMID: 34511099; PMCID: PMC8436433.</ref>		**Patient-level risk factors include male sex and overall burden of comorbidities, but also specifically [[obesity]], [[diabetes]], rheumatologic diseases (particularly [[rheumatoid arthritis]]), and heart disease (particularly [[heart failure]])<ref>Lenguerrand E, Whitehouse MR, Beswick AD, Kunutsor SK, Foguet P, Porter M, Blom AW; National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales. Lancet Infect Dis. 2019 Jun;19(6):589-600. doi: 10.1016/S1473-3099(18)30755-2. Epub 2019 Apr 17. PMID: 31005559; PMCID: PMC6531378.</ref>

	{\| class="wikitable"		{\| class="wikitable"