Prosthetic joint infections (PJI) (IDSA 2013) - Revision history

Aidan: /* Table 3: Chronic suppresive therapy */ added links and fixed typos

2020-07-08T23:35:11Z

Table 3: Chronic suppresive therapy: added links and fixed typos

← Older revision		Revision as of 23:35, 8 July 2020
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	* If unable to achieve source control despite surgery, treat for 4-6 weeks of IV or highly-bioavailable oral therapy		* If unable to achieve source control despite surgery, treat for 4-6 weeks of IV or highly-bioavailable oral therapy

	== Table 3: Chronic ~~suppresive~~ therapy ==		== Table 3: Chronic suppressive therapy ==

	{\| class="wikitable"		{\| class="wikitable"
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	! Alternative treatment		! Alternative treatment
	\|-		\|-
	\| MSSA		\| [[MSSA]]
	\| Cephalexin 500 mg PO tid to qid; <br/> Cefadroxil 500 mg PO bid		\| [[Cephalexin]] 500 mg PO tid to qid; <br/>[[Cefadroxil]] 500 mg PO bid
	\| Dicloxacillin 500 mg PO tid to qid; <br />Clindamycin 300 mg PO qid; <br />~~Amox/clav~~ 500mg PO tid		\| [[Dicloxacillin]] 500 mg PO tid to qid; <br />[[Clindamycin]] 300 mg PO qid; <br />[[Amoxicillin-clavulanic acid]] 500mg PO tid
	\|-		\|-
	\| MRSA		\| [[MRSA]]
	\| ~~Septra~~ DS 1 tab PO bid; <br />Doxycycline 100 mg PO bid		\| [[TMP-SMX]] DS 1 tab PO bid; <br />[[Doxycycline]] 100 mg PO bid
	\|		\|
	\|-		\|-
			\| [[β-hemolytic streptococci]]
	\| Beta-heme Strep
	\| ~~Pen~~ V 500 mg PO bid to qid; <br />Amoxicillin 500 mg PO tid		\| [[Penicillin V]] 500 mg PO bid to qid; <br />[[Amoxicillin]] 500 mg PO tid
	\| Cephalexin 500 mg PO tid to qid		\| [[Cephalexin]] 500 mg PO tid to qid
	\|-		\|-
	\| Enterococcus (sensitive)		\| [[Enterococcus]] (sensitive)
	\| ~~Pen~~ V 500 mg PO bid to qid; <br />Amoxicillin 500 mg PO tid		\| [[Penicillin V]] 500 mg PO bid to qid; <br />[[Amoxicillin]] 500 mg PO tid
	\|		\|
	\|-		\|-
	\| Pseudomonas		\| [[Pseudomonas]]
	\| Ciprofloxacin 250-500 mg PO bid		\| [[Ciprofloxacin]] 250-500 mg PO bid
	\|		\|
	\|-		\|-
	\| Enterobacteriaceae		\| [[Enterobacteriaceae]]
	\| ~~Septra~~ DS 1 tab PO bid		\| [[TMP-SMX]] DS 1 tab PO bid
	\| Beta-lactam, if susceptible		\| Beta-lactam, if susceptible
	\|-		\|-
	\| Cutibacterium		\| [[Cutibacterium]]
	\| ~~Pen~~ V 500 mg PO bid to qid; <br />Amoxicillin 500 mg PO tid		\| [[Penicillin V]] 500 mg PO bid to qid; <br />[[Amoxicillin]] 500 mg PO tid
	\| Cephalexin 500 mg PO tid to qid; <br />Doxycycline 100 mg PO bid		\| [[Cephalexin]] 500 mg PO tid to qid; <br />[[Doxycycline]] 100 mg PO bid
	\|}		\|}

	* may subsitute minocycline for doxycycline		* may subsitute [[minocycline]] for [[doxycycline]]

	[[Category:Bone and joint infections]]		[[Category:Bone and joint infections]]

Aidan: /* Table 3: Chronic suppresive therapy */

2020-07-08T23:32:46Z

Table 3: Chronic suppresive therapy

← Older revision		Revision as of 23:32, 8 July 2020
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	== Table 3: Chronic suppresive therapy ==		== Table 3: Chronic suppresive therapy ==

			{\| class="wikitable"
	{\|
	! Microorganism		! Microorganism
	! Preferred treatment		! Preferred treatment

Aidan: Aidan moved page Prosthetic jonit infections (PJI) (IDSA 2013) to Prosthetic joint infections (PJI) (IDSA 2013) without leaving a redirect: typo

2020-07-08T23:32:27Z

Aidan moved page Prosthetic jonit infections (PJI) (IDSA 2013) to Prosthetic joint infections (PJI) (IDSA 2013) without leaving a redirect: typo

← Older revision		Revision as of 23:32, 8 July 2020
(No difference)

Aidan at 19:40, 15 August 2019

2019-08-15T19:40:00Z

← Older revision		Revision as of 19:40, 15 August 2019
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	Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson WR; Infectious Diseases Society of America. '''Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America'''. ''Clin Infect Dis''. 2013 Jan;56(1):e1-e25. doi: [https://doi.org/10.1093/cid/cis803 10.1093/cid/cis803]. Epub 2012 Dec 6.		Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson WR; Infectious Diseases Society of America. '''Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America'''. ''Clin Infect Dis''. 2013 Jan;56(1):e1-e25. doi: [https://doi.org/10.1093/cid/cis803 10.1093/cid/cis803]. Epub 2012 Dec 6.

	= Diagnostic testing =		== Diagnostic testing ==

	== Preoperative testing ==		=== Preoperative testing ===

	* Presentation		* Presentation
Line 34:		Line 34:
	*** If stable, off antibiotics for at least 2 weeks		*** If stable, off antibiotics for at least 2 weeks

	== Intraoperative diagnosis ==		=== Intraoperative diagnosis ===

	* Tissue cultures		* Tissue cultures
Line 40:		Line 40:
	** If stable, off antibiotics for at least 2 weeks		** If stable, off antibiotics for at least 2 weeks

	= Definition of PJI =		== Definition of PJI ==

	* Definite		* Definite
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	* PJI possible even without the above		* PJI possible even without the above

	= Surgical management =		== Surgical management ==

	* Debridement and retention		* Debridement and retention
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	** Last-line option for selected, usually life-threatening cases		** Last-line option for selected, usually life-threatening cases

	= Management after debridement and rentention =		== Management after debridement and rentention ==

	== Staphylococcus spp. ==		=== Staphylococcus spp. ===

	* 2-6 weeks of pathogen-specific IV therapy with rifampin 300-450 mg PO BID, followed by oral therapy with rifampin		* 2-6 weeks of pathogen-specific IV therapy with rifampin 300-450 mg PO BID, followed by oral therapy with rifampin
Line 80:		Line 80:
	* Duration 3 months for hip, elbow, shoulder, ankle		* Duration 3 months for hip, elbow, shoulder, ankle

	== Chronic suppressive therapy ==		=== Chronic suppressive therapy ===

	* May follow above regimen		* May follow above regimen
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	* Do not use rifampin, either alone or in combination		* Do not use rifampin, either alone or in combination

	== Other organisms ==		=== Other organisms ===

	* 4-6 weeks of pathogen-specific IV or highly-bioavailable oral therapy		* 4-6 weeks of pathogen-specific IV or highly-bioavailable oral therapy
	* May need chronic suppressive therapy		* May need chronic suppressive therapy

	= Management after resection with or without reimplantation =		== Management after resection with or without reimplantation ==

	* 4-6 weeks of IV or highly bioavailable oral therapy		* 4-6 weeks of IV or highly bioavailable oral therapy

	= Management after 1-stage exchange =		== Management after 1-stage exchange ==

	== Staphylococcus spp. ==		=== Staphylococcus spp. ===

	* Identical to management with debridement and retention		* Identical to management with debridement and retention
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	* May follow with indeifinite chronic oral suppressive therapy, without rifampin		* May follow with indeifinite chronic oral suppressive therapy, without rifampin

	== Other organisms ==		=== Other organisms ===

	* 4-6 weeks of IV therapy or highly-bioavailable oral therapy		* 4-6 weeks of IV therapy or highly-bioavailable oral therapy
	* May follow with chronic supressive therapy		* May follow with chronic supressive therapy

	== Management after amputation ==		=== Management after amputation ===

	* If no longer septic and source control has been achieved, treat for 24-48 hours further		* If no longer septic and source control has been achieved, treat for 24-48 hours further
	* If unable to achieve source control despite surgery, treat for 4-6 weeks of IV or highly-bioavailable oral therapy		* If unable to achieve source control despite surgery, treat for 4-6 weeks of IV or highly-bioavailable oral therapy

	= Table 3: Chronic suppresive therapy =		== Table 3: Chronic suppresive therapy ==

	{\|		{\|
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	[[Category:Bone and joint infections]]		[[Category:Bone and joint infections]]
			[[Category:IDSA guidelines]]

Aidan at 17:38, 13 August 2019

2019-08-13T17:38:43Z

← Older revision		Revision as of 17:38, 13 August 2019
Line 153:		Line 153:

	* may subsitute minocycline for doxycycline		* may subsitute minocycline for doxycycline

			[[Category:Bone and joint infections]]

Aidan at 17:38, 13 August 2019

2019-08-13T17:38:22Z

← Older revision		Revision as of 17:38, 13 August 2019
Line 1:		Line 1:
			Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson WR; Infectious Diseases Society of America. '''Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America'''. ''Clin Infect Dis''. 2013 Jan;56(1):e1-e25. doi: [https://doi.org/10.1093/cid/cis803 10.1093/cid/cis803]. Epub 2012 Dec 6.
	= Diagnosis and Management of Prosthetic Joint Infection (IDSA 2012) =

	== Diagnostic testing ==		= Diagnostic testing =

	=== Preoperative testing ===		== Preoperative testing ==

	* Presentation		* Presentation
Line 34:		Line 34:
	*** If stable, off antibiotics for at least 2 weeks		*** If stable, off antibiotics for at least 2 weeks

	=== Intraoperative diagnosis ===		== Intraoperative diagnosis ==

	* Tissue cultures		* Tissue cultures
Line 40:		Line 40:
	** If stable, off antibiotics for at least 2 weeks		** If stable, off antibiotics for at least 2 weeks

	== Definition of PJI ==		= Definition of PJI =

	* Definite		* Definite
Line 51:		Line 51:
	* PJI possible even without the above		* PJI possible even without the above

	== Surgical management ==		= Surgical management =

	* Debridement and retention		* Debridement and retention
Line 69:		Line 69:
	** Last-line option for selected, usually life-threatening cases		** Last-line option for selected, usually life-threatening cases

	== Management after debridement and rentention ==		= Management after debridement and rentention =

	=== Staphylococcus spp. ===		== Staphylococcus spp. ==

	* 2-6 weeks of pathogen-specific IV therapy with rifampin 300-450 mg PO BID, followed by oral therapy with rifampin		* 2-6 weeks of pathogen-specific IV therapy with rifampin 300-450 mg PO BID, followed by oral therapy with rifampin
Line 80:		Line 80:
	* Duration 3 months for hip, elbow, shoulder, ankle		* Duration 3 months for hip, elbow, shoulder, ankle

	==== Chronic suppressive therapy ====		== Chronic suppressive therapy ==

	* May follow above regimen		* May follow above regimen
Line 86:		Line 86:
	* Do not use rifampin, either alone or in combination		* Do not use rifampin, either alone or in combination

	=== Other organisms ===		== Other organisms ==

	* 4-6 weeks of pathogen-specific IV or highly-bioavailable oral therapy		* 4-6 weeks of pathogen-specific IV or highly-bioavailable oral therapy
	* May need chronic suppressive therapy		* May need chronic suppressive therapy

	== Management after resection with or without reimplantation ==		= Management after resection with or without reimplantation =

	* 4-6 weeks of IV or highly bioavailable oral therapy		* 4-6 weeks of IV or highly bioavailable oral therapy

	== Management after 1-stage exchange ==		= Management after 1-stage exchange =

	=== Staphylococcus spp. ===		== Staphylococcus spp. ==

	* Identical to management with debridement and retention		* Identical to management with debridement and retention
Line 106:		Line 106:
	* May follow with indeifinite chronic oral suppressive therapy, without rifampin		* May follow with indeifinite chronic oral suppressive therapy, without rifampin

	=== Other organisms ===		== Other organisms ==

	* 4-6 weeks of IV therapy or highly-bioavailable oral therapy		* 4-6 weeks of IV therapy or highly-bioavailable oral therapy
	* May follow with chronic supressive therapy		* May follow with chronic supressive therapy

	=== Management after amputation ===		== Management after amputation ==

	* If no longer septic and source control has been achieved, treat for 24-48 hours further		* If no longer septic and source control has been achieved, treat for 24-48 hours further
	* If unable to achieve source control despite surgery, treat for 4-6 weeks of IV or highly-bioavailable oral therapy		* If unable to achieve source control despite surgery, treat for 4-6 weeks of IV or highly-bioavailable oral therapy

	== Table 3: Chronic suppresive therapy ==		= Table 3: Chronic suppresive therapy =

	{\|		{\|

Aidan: Aidan moved page IDSA PJI 2013 to Prosthetic jonit infections (PJI) (IDSA 2013) without leaving a redirect

2019-08-13T17:36:15Z

Aidan moved page IDSA PJI 2013 to Prosthetic jonit infections (PJI) (IDSA 2013) without leaving a redirect

← Older revision		Revision as of 17:36, 13 August 2019
(No difference)

Maintenance script: Imported from text file

2019-08-11T18:05:53Z

Imported from text file

New page

= Diagnosis and Management of Prosthetic Joint Infection (IDSA 2012) =

== Diagnostic testing ==

=== Preoperative testing ===

* Presentation
** Sinus tract or persistent wound drainage
** Acute onset of pain
** Chronic pain at any time after implantation
*** After a pain-free interval
*** In the first few years
*** With a history of wound healing problems or site infection
* Evaluation
** History and physical
*** Type of prosthesis
*** Date of implantation
*** Past surgeries on the joint
*** History of wound healing problems following implantation
*** Remote infections
*** Current symptoms
*** Drug allergies
*** Comorbid conditions
*** Prior and current microbiology results
*** Prior and current antimicrobial therapy
** Bloodwork
*** ESR/CRP
*** Blood cultures if fever, acute onset, or suspicion of bloodstream infection
** Imaging
*** Plain radiograph
*** Do not routinely use bone/WBC scans, MRI, CT, or PET
** Diagnostic arthrocentesis
*** Should be performed if above investigations suggest infection, unless surgery is planned and antimicrobials can be withheld before surgery
*** If stable, off antibiotics for at least 2 weeks

=== Intraoperative diagnosis ===

* Tissue cultures
** At least 3, ideally 5 or 6
** If stable, off antibiotics for at least 2 weeks

== Definition of PJI ==

* Definite
** Sinus tract that communicates with the prosthesis
** Purulence surrounding the prosthesis, without another etiology
** Two or more intraoperative cultures with the same organism
* Suggestive
** Acute inflammation on histopathology
** A single positive intraoperative cultures for a vierulent organism
* PJI possible even without the above

== Surgical management ==

* Debridement and retention
** Well-fixed prosthesis, no sinus tract, within 30 days of implantation or 3 weeks of symptom onset
** Not meeting the above criteria but with unacceptable surgical risk
* 2-stage
** Not candidates for a 1-stage and are medically able to undergo multiple surgeries
** Obtain a baseline ESR/CRP
* 1-stage
** THA infection, good soft tissue, known susceptible pathogen that can be treated with antibiotics that have good oral bioavailability
* Permanent resection
** non-ambulatory patients
** Limited bone stock, poor soft tissue coverage, or highly resistant organisms
** Medical condition precluding multiple major surgeries
** Failed 2-stage with high risk of recurrence
* Amputation
** Last-line option for selected, usually life-threatening cases

== Management after debridement and rentention ==

=== Staphylococcus spp. ===

* 2-6 weeks of pathogen-specific IV therapy with rifampin 300-450 mg PO BID, followed by oral therapy with rifampin
** Recommended oral therapy includes ciprofloxacin and levofloxacin
** Alternatives include Septra, doxycycline/minocycline, first-generation cephalosporins, or antistaphylococcal penicillins
** If unable to tolerate rifampin, should treat with 4-6 weeks of IV
* Duration 6 months for knee
* Duration 3 months for hip, elbow, shoulder, ankle

==== Chronic suppressive therapy ====

* May follow above regimen
* Recommended oral therapy includes cephalexin, dicloxacillin, co-trimoxazole, and minocycline
* Do not use rifampin, either alone or in combination

=== Other organisms ===

* 4-6 weeks of pathogen-specific IV or highly-bioavailable oral therapy
* May need chronic suppressive therapy

== Management after resection with or without reimplantation ==

* 4-6 weeks of IV or highly bioavailable oral therapy

== Management after 1-stage exchange ==

=== Staphylococcus spp. ===

* Identical to management with debridement and retention
* 2-6 weeks of IV therapy plus rifampin 300-450 mg PO bid, followed by oral plus rifampin for total of 3 months
** Recommended oral therapy includes ciprofloxacin or levofloxacin
** Alternative oral therapy includes Septra, doxycycline/minocycline, first-generation cephalosporins, or antistaph penicillins
** If unable to tolerate rifampin, treat for 4-6 weeks of IV therapy
* May follow with indeifinite chronic oral suppressive therapy, without rifampin

=== Other organisms ===

* 4-6 weeks of IV therapy or highly-bioavailable oral therapy
* May follow with chronic supressive therapy

=== Management after amputation ===

* If no longer septic and source control has been achieved, treat for 24-48 hours further
* If unable to achieve source control despite surgery, treat for 4-6 weeks of IV or highly-bioavailable oral therapy

== Table 3: Chronic suppresive therapy ==

{|
! Microorganism
! Preferred treatment
! Alternative treatment
|-
| MSSA
| Cephalexin 500 mg PO tid to qid; Cefadroxil 500 mg PO bid
| Dicloxacillin 500 mg PO tid to qid; Clindamycin 300 mg PO qid; Amox/clav 500mg PO tid
|-
| MRSA
| Septra DS 1 tab PO bid; Doxycycline 100 mg PO bid
|
|-
| Beta-heme Strep
| Pen V 500 mg PO bid to qid; Amoxicillin 500 mg PO tid
| Cephalexin 500 mg PO tid to qid
|-
| Enterococcus (sensitive)
| Pen V 500 mg PO bid to qid; Amoxicillin 500 mg PO tid
|
|-
| Pseudomonas
| Ciprofloxacin 250-500 mg PO bid
|
|-
| Enterobacteriaceae
| Septra DS 1 tab PO bid
| Beta-lactam, if susceptible
|-
| Cutibacterium
| Pen V 500 mg PO bid to qid; Amoxicillin 500 mg PO tid
| Cephalexin 500 mg PO tid to qid; Doxycycline 100 mg PO bid
|}

* may subsitute minocycline for doxycycline