Factors related to outcome of early and delayed prosthetic joint infections

T. Ascione, P. Pagliano, M. Mariconda, R. Rotondo, G. Balato, A. Toro, V. Barletta, M. Conte, S. Esposito

Research output: Contribution to journalArticle

Abstract

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. Patients and methods: 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. Results: 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%, Staphylococcus aureus in 28%, and Pseudomonas aeruginosa 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. Conclusion: Appropriate diagnostic and surgical procedures and microbiologically driven antibiotic therapy including rifampin are recommended to improve diagnostic accuracy and outcome.

Original languageEnglish
Pages (from-to)30-36
Number of pages7
JournalJournal of Infection
Volume70
Issue number1
DOIs
Publication statusPublished - Jan 1 2015

Keywords

  • Diagnosis
  • Infection
  • Prosthetic joint infections
  • Surgical implant
  • Treatment

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases
  • Medicine(all)

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