Factors related to outcome of early and delayed prosthetic joint infections. Issue 1 (January 2015)

• Record Type: Journal Article
• Authors: Ascione, T.; Pagliano, P.; Mariconda, M.; Rotondo, R.; Balato, G.; Toro, A.; Barletta, V.; Conte, M.; Esposito, S.
• Is Part Of: Journal of infection. Volume 70:Issue 1(2015)
• Page Start: 30
• Page End: 36
• Publication Date: 2015-01
• Subjects: Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2014.07.008
• Languages: English
• ISSNs: 0163-4453

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title id="sectitle0010">Summary</title> <sec> <p id="abspara0010">In this prospective study, we evaluate the impact of adherence to a diagnostic and therapeutic protocol on prosthetic joint infections (PJI) diagnostic accuracy and outcome.</p> </sec> <sec> <title id="sectitle0015">Patients and methods</title> <p id="abspara0015">Patients with early or delayed PJI referred over a 5-year period were included. Diagnosis was based on characteristic clinical signs, radiographic findings and microbiological evidence. Antibiotics were chosen on the basis of microbiological findings, and drugs active against methicillin-resistant staphylococci were administered if no microbiological evidence had been obtained.</p> </sec> <sec> <title id="sectitle0020">Results</title> <p id="abspara0020">Inclusion criteria were met in 159 cases (median age 64 years, males 45%). 56 were early infections and 103 delayed infections. Comorbidities were reported in 99 (62%) cases. Positive cultures were obtained in 122/159 (77%), coagulase-negative staphylococci were cultured in 20%, <italic>Staphylococcus aureus</italic> in 28%, and <italic>Pseudomonas aeruginosa</italic> in 7%. In early infections, cure rate after debridement and antibiotic therapy was 80%. In delayed infections, cure rate after two-stage exchange was 85%. Of 28 patients with delayed infection treated with antibiotics without surgery, only 8 (29%) infections were suppressed 48 weeks after treatment discontinuation. Rifampin afforded a better outcome.</p> </sec> <sec> <title id="sectitle0025">Conclusion</title> <p id="abspara0025">Appropriate diagnostic and surgical procedures and microbiologically driven antibiotic therapy including rifampin are recommended to improve diagnostic accuracy and outcome.</p> </sec> </abstract>