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 language | English |
|---|---|
| Pages (from-to) | 30-36 |
| Number of pages | 7 |
| Journal | Journal of Infection |
| Volume | 70 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 1 2015 |
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Keywords
- Diagnosis
- Infection
- Prosthetic joint infections
- Surgical implant
- Treatment
ASJC Scopus subject areas
- Microbiology (medical)
- Infectious Diseases
- Medicine(all)
Cite this
Factors related to outcome of early and delayed prosthetic joint infections. / Ascione, T.; Pagliano, P.; Mariconda, M.; Rotondo, R.; Balato, G.; Toro, A.; Barletta, V.; Conte, M.; Esposito, S.
In: Journal of Infection, Vol. 70, No. 1, 01.01.2015, p. 30-36.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Factors related to outcome of early and delayed prosthetic joint infections
AU - Ascione, T.
AU - Pagliano, P.
AU - Mariconda, M.
AU - Rotondo, R.
AU - Balato, G.
AU - Toro, A.
AU - Barletta, V.
AU - Conte, M.
AU - Esposito, S.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - 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.
AB - 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.
KW - Diagnosis
KW - Infection
KW - Prosthetic joint infections
KW - Surgical implant
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=84916884761&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84916884761&partnerID=8YFLogxK
U2 - 10.1016/j.jinf.2014.07.008
DO - 10.1016/j.jinf.2014.07.008
M3 - Article
C2 - 25077990
AN - SCOPUS:84916884761
VL - 70
SP - 30
EP - 36
JO - Journal of Infection
JF - Journal of Infection
SN - 0163-4453
IS - 1
ER -