Prosthetic joint infection: Difference between revisions
From IDWiki
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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 15:00, 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
- ^ 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.
- ^ 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.