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Management of Periprosthetic Joint Infection

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Prosthetic Joint Infections

Abstract

The management of periprosthetic joint infections is a challenging issue, needing a combined medical and surgical approach. The presence of antibiotic-tolerant biofilm-embedded bacteria will demand a sophisticated antimicrobial treatment, influenced by the surgical treatment chosen. In this regard, the main surgical alternatives are curative attempt with prosthesis retention, curative attempt with prosthesis removal and palliative treatment with prosthesis retention. The choice for one of these depends on the patient’s baseline condition, the aetiology of the infection and the clinical presentation. Acute cases with periprosthetic soft tissue in good condition, a soundly fixed prosthesis, and caused by microorganisms susceptible to antibiotics with a good anti-biofilm profile, can be managed by debridement and prosthesis retention. Chronic cases or episodes not meeting these conditions should be managed with prosthesis removal and submitted to a one- or two-step exchange procedure or to joint arthrodesis. Alternatively, patients with significant comorbidities precluding aggressive surgical approaches and with stable and free-pain prosthesis could be managed with long-term suppressive antibiotics. For staphylocococci, rifampin plus levofloxacin is the treatment of choice. Other alternative rifampin-based combinations may be also suitable for treating these infections. In the case of Gram-negative bacilli, ciprofloxacin is recommended as the first-line treatment. For enterococci and streptococci, β-lactams are the preferred treatment, and some evidence suggests the benefits of adding rifampin. Further research is needed to find alternative treatments when these are not available.

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Abbreviations

AUC:

Area under the curve

CNS:

Coagulase-negative staphylococci

CRP:

C-reactive protein

DAIR:

Debridement, antibiotics and implant retention

ESBL:

Extended-spectrum β-lactamase

ID:

Infectious disease (physician)

IDSA:

Infectious Diseases Society of America

MBC:

Minimal bactericidal concentration

MBCstat :

Minimal bactericidal concentration for bacteria in a stationary state of growth

MBEC:

Minimal biofilm eradication concentration

MBIC:

Minimal biofilm inhibitory concentration

MIC:

Minimal inhibitory concentration

MRSA:

Methicillin-resistant Staphylococcus aureus

MSSA:

Methicillin-susceptible Staphylococcus aureus

PJI:

Periprosthetic joint infection

SAT:

Suppressive antimicrobial treatment

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Acknowledgments

We thank Michael Maudsley (Universidad de Barcelona) for reviewing the English manuscript. J. L-T is supported by a clinical research contract “Sara Borrell” (Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, CD14/00176).

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  1. Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación “i+12”, Hospital Univ. 12 de Octubre, Servicio de Medicina Interna (Planta 13), Avda. Córdoba s/n., 28041, Madrid, Spain

    Jaime Lora-Tamayo

  2. Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, Feixa Llarga s/n. 08907 L’Hospitalet de Llobregat, Barcelona, Spain

    Oscar Murillo

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Correspondence to Jaime Lora-Tamayo .

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  1. Department of Infectious Diseases, Monash University and Alfred Health, Melbourne, Victoria, Australia

    Trisha Peel

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Lora-Tamayo, J., Murillo, O. (2018). Management of Periprosthetic Joint Infection. In: Peel, T. (eds) Prosthetic Joint Infections. Springer, Cham. https://doi.org/10.1007/978-3-319-65250-4_4

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