Prosthetic joint infection: Difference between revisions
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*Bacteria grown on the prosthesis in a biofilm, making it resistant to medical management |
*Bacteria grown on the prosthesis in a biofilm, making it resistant to medical management |
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== Management == |
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=== Surgical Therapy === |
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* Ultimately the decision of whether and how to treat surgically rests with the orthopedic surgeon |
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=== Antimicrobial Therapy === |
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{| class="wikitable" |
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!Surgical Management |
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!Species |
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!Location |
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!Duration IV |
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!Total Duration |
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!Adjunctive Rifampin |
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!Chronic Suppressive Thearpy |
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|- |
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|debridement and retention |
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|[[Staphylococcus species]] |
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|knee |
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|2-6 weeks |
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|6 months |
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|yes; 4-6 weeks IV if not given |
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|± |
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|- |
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|debridement and retention |
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|[[Staphylococcus species]] |
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|hip |
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|2-6 weeks |
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|3 months |
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|yes; 4-6 weeks IV if not given |
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|± |
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|- |
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|debridement and retention |
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|[[Staphylococcus species]] |
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|elbow |
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|2-6 weeks |
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|3 months |
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|yes; 4-6 weeks IV if not given |
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|± |
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|- |
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|debridement and retention |
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|[[Staphylococcus species]] |
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|shoulder |
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|2-6 weeks |
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|3 months |
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|yes; 4-6 weeks IV if not given |
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|± |
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|- |
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|debridement and retention |
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|[[Staphylococcus species]] |
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|ankle |
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|2-6 weeks |
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|3 months |
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|yes; 4-6 weeks IV if not given |
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|± |
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|- |
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|debridement and retention |
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|species other than staphylococci |
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|— |
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|4-6 weeks |
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| |
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| |
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|± |
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|- |
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|resection ± reimplantation |
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|— |
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|— |
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|4-6 weeks |
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| |
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| |
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| |
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|- |
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|1-stage exchange |
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|[[Staphylococcus species]] |
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|— |
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|2-6 weeks |
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|3 months |
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|yes; 4-6 weeks IV if not given |
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|± |
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|- |
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|1-stage exchange |
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|species other than staphylococci |
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|— |
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|4-6 weeks |
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|3 months |
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| |
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|± |
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|- |
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|amputation with source control |
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|— |
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|— |
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|24-48 hours |
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| |
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| |
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| |
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|- |
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|amputation without source control |
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|— |
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|— |
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|4-6 weeks |
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| |
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| |
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| |
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|} |
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=== Chronic Suppressive Therapy === |
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{| class="wikitable" |
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!Microorganism |
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!Preferred treatment |
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!Alternative treatment |
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|- |
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|[[MSSA]] |
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|[[Cephalexin]] 500 mg PO tid to qid; |
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[[Cefadroxil]] 500 mg PO bid |
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|[[Dicloxacillin]] 500 mg PO tid to qid; |
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[[Clindamycin]] 300 mg PO qid; |
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[[Amoxicillin-clavulanic acid]] 500mg PO tid |
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|- |
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|[[MRSA]] |
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|[[TMP-SMX]] DS 1 tab PO bid; |
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[[Doxycycline]] 100 mg PO bid |
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| |
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|- |
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|[[β-hemolytic streptococci]] |
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|[[Penicillin V]] 500 mg PO bid to qid; |
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[[Amoxicillin]] 500 mg PO tid |
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|[[Cephalexin]] 500 mg PO tid to qid |
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|- |
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|[[Enterococcus]] (sensitive) |
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|[[Penicillin V]] 500 mg PO bid to qid; |
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[[Amoxicillin]] 500 mg PO tid |
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| |
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|- |
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|[[Pseudomonas]] |
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|[[Ciprofloxacin]] 250-500 mg PO bid |
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| |
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|- |
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|[[Enterobacteriaceae]] |
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|[[TMP-SMX]] DS 1 tab PO bid |
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|Beta-lactam, if susceptible |
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|- |
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|[[Cutibacterium]] |
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|[[Penicillin V]] 500 mg PO bid to qid; |
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[[Amoxicillin]] 500 mg PO tid |
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|[[Cephalexin]] 500 mg PO tid to qid; |
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[[Doxycycline]] 100 mg PO bid |
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|} |
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==Further Reading== |
==Further Reading== |
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Revision as of 19:00, 27 August 2020
Background
Microbiology
- Hip and knee
- Early (<3 months): Staphylococcus aureus (38%), aerobic Gram-negative bacilli (24%), coagulase-negative staphylococci (22%), Enterococcus species (10%), and Streptococcus species (4%), anaerobes including Cutibacterium acnes (3%), culture-negative (10%); 31% are polymicrobial
- Overall: Staphylococcus aureus (27%), coagulase-negative staphylococci (27%), aerobic Gram-negative bacilli (9%), Streptococcus species (8%), anaerobes including Cutibacterium acnes (4%), Enterococcus species (3%), culture-negative (14%); 15% are polymicrobial
- Shoulder: coagulase-negative staphylococci (42%), Cutibacterium acnes (24%), Staphylococcus aureus (18%), aerobic Gram-negative bacilli (10%), others, culture-negative (15%); polymicrobial in 16%
- Elbow: Staphylococcus aureus (42%), coagulase-negative staphylococci (41%), others, culture-negative (5%); polymicrobial in 3%
Epidemiology
- Complicates about 2% of arthroplasty
Pathophysiology
- Bacteria grown on the prosthesis in a biofilm, making it resistant to medical management
Management
Surgical Therapy
- Ultimately the decision of whether and how to treat surgically rests with the orthopedic surgeon
Antimicrobial Therapy
| Surgical Management | Species | Location | Duration IV | Total Duration | Adjunctive Rifampin | Chronic Suppressive Thearpy |
|---|---|---|---|---|---|---|
| debridement and retention | Staphylococcus species | knee | 2-6 weeks | 6 months | yes; 4-6 weeks IV if not given | ± |
| debridement and retention | Staphylococcus species | hip | 2-6 weeks | 3 months | yes; 4-6 weeks IV if not given | ± |
| debridement and retention | Staphylococcus species | elbow | 2-6 weeks | 3 months | yes; 4-6 weeks IV if not given | ± |
| debridement and retention | Staphylococcus species | shoulder | 2-6 weeks | 3 months | yes; 4-6 weeks IV if not given | ± |
| debridement and retention | Staphylococcus species | ankle | 2-6 weeks | 3 months | yes; 4-6 weeks IV if not given | ± |
| debridement and retention | species other than staphylococci | — | 4-6 weeks | ± | ||
| resection ± reimplantation | — | — | 4-6 weeks | |||
| 1-stage exchange | Staphylococcus species | — | 2-6 weeks | 3 months | yes; 4-6 weeks IV if not given | ± |
| 1-stage exchange | species other than staphylococci | — | 4-6 weeks | 3 months | ± | |
| amputation with source control | — | — | 24-48 hours | |||
| amputation without source control | — | — | 4-6 weeks |
Chronic Suppressive 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; Amoxicillin-clavulanic acid 500mg PO tid |
| MRSA | TMP-SMX DS 1 tab PO bid;
Doxycycline 100 mg PO bid |
|
| β-hemolytic streptococci | Penicillin V 500 mg PO bid to qid;
Amoxicillin 500 mg PO tid |
Cephalexin 500 mg PO tid to qid |
| Enterococcus (sensitive) | Penicillin V 500 mg PO bid to qid;
Amoxicillin 500 mg PO tid |
|
| Pseudomonas | Ciprofloxacin 250-500 mg PO bid | |
| Enterobacteriaceae | TMP-SMX DS 1 tab PO bid | Beta-lactam, if susceptible |
| Cutibacterium | Penicillin V 500 mg PO bid to qid;
Amoxicillin 500 mg PO tid |
Cephalexin 500 mg PO tid to qid;
Doxycycline 100 mg PO bid |
Further Reading
- Prosthetic Joint Infection. Clin Micro Rev. 2014;27(2):302-345. doi: 10.1128/CMR.00111-13
- Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the IDSA. Clin Infect Dis. 2013;56(1):e1-25. doi: 10.1093/cid/cis803
References
- a b c Louis Bernard, Cédric Arvieux, Benoit Brunschweiler, Sophie Touchais, Séverine Ansart, Jean-Pierre Bru, Eric Oziol, Cyril Boeri, Guillaume Gras, Jérôme Druon, Philippe Rosset, Eric Senneville, Houcine Bentayeb, Damien Bouhour, Gwenaël Le Moal, Jocelyn Michon, Hugues Aumaître, Emmanuel Forestier, Jean-Michel Laffosse, Thierry Begué, Catherine Chirouze, Fréderic-Antoine Dauchy, Edouard Devaud, Benoît Martha, Denis Burgot, David Boutoille, Eric Stindel, Aurélien Dinh, Pascale Bemer, Bruno Giraudeau, Bertrand Issartel, Agnès Caille. Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection. New England Journal of Medicine. 2021;384(21):1991-2001. doi:10.1056/nejmoa2020198.
- ^ Joshua S Davis, Sarah Metcalf, Benjamin Clark, J Owen Robinson, Paul Huggan, Chris Luey, Stephen McBride, Craig Aboltins, Renjy Nelson, David Campbell, L Bogdan Solomon, Kellie Schneider, Mark R Loewenthal, Piers Yates, Eugene Athan, Darcie Cooper, Babak Rad, Tony Allworth, Alistair Reid, Kerry Read, Peter Leung, Archana Sud, Vana Nagendra, Roy Chean, Chris Lemoh, Nora Mutalima, Ton Tran, Kate Grimwade, Marjoree Sehu, Davis Looke, Adrienne Torda, Thi Aung, Steven Graves, David L Paterson, Laurens Manning. Predictors of treatment success following peri-prosthetic joint infection: 24-month follow up from a multi-center prospective observational cohort study of 653 patients. Open Forum Infectious Diseases. 2022. doi:10.1093/ofid/ofac048.
- ^ Javad Parvizi, Timothy L. Tan, Karan Goswami, Carlos Higuera, Craig Della Valle, Antonia F. Chen, Noam Shohat. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. The Journal of Arthroplasty. 2018;33(5):1309-1314.e2. doi:10.1016/j.arth.2018.02.078.
- ^ Werner Zimmerli, Parham Sendi. Role of Rifampin against Staphylococcal Biofilm InfectionsIn Vitro, in Animal Models, and in Orthopedic-Device-Related Infections. Antimicrobial Agents and Chemotherapy. 2018;63(2):e01746-18. doi:10.1128/aac.01746-18.
- ^ James B. Doub, Emily L. Heil, Afua Ntem-Mensah, Renaldo Neeley, Patrick R. Ching. Rifabutin Use in Staphylococcus Biofilm Infections: A Case Series. Antibiotics. 2020;9(6):326. doi:10.3390/antibiotics9060326.
