Postoperative Joint Infections Research Articles

Prosthesis Retention, Serial Debridement, and Antibiotic Bead Use for the Treatment of Infection Following Total Joint Arthroplasty

The clinical outcomes of a consecutive series of deep total joint infections treated with a prosthesis retaining protocol were reviewed. Each patient underwent surgical treatment consisting of serial irrigation and debridements, polyethylene exchange when applicable, interval placement and exchange of intra-articular tobramycin/vancomycin-impregnated polymethylmethacrylate beads and 6 weeks of intravenous antibiotics. The primary outcome measures were clinical, radiographic, or laboratory evidence of recurrent prosthetic infection or revision total joint arthroplasty for any reason. At a mean follow-up of 37 months (range, 23-41 months), all infections were eradicated while retaining prosthetic components. No further operative intervention was required for any patient. This treatment protocol can be successful in appropriately selected patients, presenting with early postoperative or acute hematogenous deep total joint infections.

Efficacy and safety of vancomycin constant-rate infusion in the treatment of chronic Gram-positive bone and joint infections

OBJECTIVE: To evaluate the efficacy and safety of vancomycin constant-rate infusion over 24 h in the treatment of Gram-positive bone infections, METHODS: Vancomycin (40 mg/kg/day) was administered without a loading dose to 15 patients (12 male, three female) aged 23--90 years, weighing 46--85 kg, with postoperative chronic bone and joint infections. The 24-h dose was adjusted to maintain plasma levels between 25 and 35 mg/L. Mean duration of therapy was 6.2 months (4--8.5) via a portable infusion pump. Sites of infection included hip and femur (10), tibia (three), patella (one) and vertebrae (one). Sequestrectomy (two), removal of material (7/8 prosthetic hips, 1/5 metal implants) and debridement (two) were performed at the beginning of the treatment. Involved bacteria included Staphylococcus aureus (eight, six methicillin resistant), S. epidermidis (four methicillin-resistant), Enterococcus faecalis (one), Enterococcus avium (one) and Streptococcus bovis (one). RESULTS: MIC of vancomycin ranged from 1 to 4 mg/L. The mean vancomycin bone concentration when available was 67.7plus minus38.9 microg/L. Based on a mean post-treatment follow-up of 14plus minus4 months (6--20.6), cure was achieved in 10 patients (66.6%). Failures were related to the inability to remove the infected prosthesis (one) or implants (three) and to the persistence of a deep wound abcess (one). Adverse events included pruritus (four cases), tinnitus (two), mild transient elevation of creatinine level (three) and transient neutropenia (two). Vancomycin was maintained in all the patients. CONCLUSIONS: Prolonged treatment with vancomycin constant-rate infusion is effective and safe for treatment of Gram-positive chronic bone and joint infections, providing that complete surgical débridement and prosthetic material removal are performed.

Urinary tract sequelae: possible influence on joint infections following total joint replacement.

A total of 277 patients receiving 364 total joint replacements in a period of 2 years were analyzed to determine whether urinary tract sequelae (infections, catheterization, and genitourinary instrumentation) encountered preoperatively or perioperatively had any significant influence on the development of postoperative joint infections. Three of these patients developed joint injections, none as a result of urinary tract infection. None of these infected patients required any catheterizations or instrumentation of the genitourinary system postoperatively. To enhance the previous data, all joint infections encountered in a period of 16 years were analyzed using the same criteria. Only one infection spread hematogenously from a urinary tract infection, and this occurred 20 months after surgery. The results of this study show no correlation between preoperative or perioperative urinary tract sequelae and postoperative joint infections. Bacteriuria should not be considered a contraindication for total joint replacement.