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Oral Antibiotics are Effective for Highly Resistant Hip Arthroplasty Infections

  • Symposium: Papers Presented at the Annual Closed Meeting of the International Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Infected arthroplasties reportedly have a lower eradication rate when caused by highly resistant and/or polymicrobial isolates and in these patients most authors recommend intravenous antibiotics. We asked whether two-stage revision with interim oral antibiotics could eradicate these infections. We prospectively followed 36 patients (mean age, 71.8 years) with late hip arthroplasty infections. Combinations of oral antibiotics were prescribed according to cultures, biofilm, and intracellular effectiveness. The minimum followup was 1 year (mean, 4.4 years; range, 1–12 years). We presumed eradication in the absence of clinical, serologic, and radiographic signs of infection. Infection was eradicated in all 13 patients with highly resistant bacteria who completed a two-stage protocol (10 with methicillin-resistant Staphylococci) and in eight of 11 patients treated with only the first stage (and six of nine with methicillin-resistant Staphylococci). Infection was eradicated in six of six patients with polymicrobial isolates (of sensitive and/or resistant bacteria) who completed a two-stage protocol and in five of seven with polymicrobial isolates treated with only the first surgery. The Harris hip score averaged 88.1 (range, 70–98) in patients who underwent reimplantation and 56.8 (range, 32–76) in patients who underwent resection arthroplasty. Long cycles of combined oral antibiotics plus a two-stage surgical exchange appear a promising alternative for infections by highly resistant bacteria, methicillin-resistant Staphylococci, and polymicrobial infections.

Level of Evidence: Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Cirugía Ortopédica y Traumatología, Hospital Universitario La Princesa, Océano Antártico 41, Tres Cantos, 28760, Madrid, Spain

    José Cordero-Ampuero MD, PhD

  2. Microbiología, Fundación Jiménez Díaz-UTE, Madrid, Spain

    Jaime Esteban MD, PhD

  3. Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz, Madrid, Spain

    Eduardo García-Cimbrelo MD, PhD

Authors
  1. José Cordero-Ampuero MD, PhD
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  2. Jaime Esteban MD, PhD
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  3. Eduardo García-Cimbrelo MD, PhD
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Correspondence to José Cordero-Ampuero MD, PhD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Cordero-Ampuero, J., Esteban, J. & García-Cimbrelo, E. Oral Antibiotics are Effective for Highly Resistant Hip Arthroplasty Infections. Clin Orthop Relat Res 467, 2335–2342 (2009). https://doi.org/10.1007/s11999-009-0808-8

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  • DOI: https://doi.org/10.1007/s11999-009-0808-8

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