What should be considered when providing organism-specific therapy to treat septic arthritis of prosthetic joints?

Updated: Oct 01, 2020
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Answer

See the list below:

  • The sensitivity of cultures of synovial fluid ranges from 45 to 100%.
  • Culture results of periprosthetic tissues have a sensitivity ranging from 65 to 94%. [12, 13]
  • Blood cultures should be obtained in all patients with suspected PJI. [14]
  • In PJI, plain radiography can detect new subperiosteal bone growth and transcortical sinus tracts—both are signs of active infection.
  • The 2-stage joint-replacement procedure is the preferred surgical procedure; the prosthesis is removed, and an antibiotic-impregnated spacer is placed after thorough debridement of the infected tissue; IV antibiotics are delivered for 6-8wk before the new joint is implanted. [12]
  • The 1-stage joint-replacement procedure consists of simultaneous removal and replacement of the joint, and it is usually employed in patients with highly sensitive organisms; however, the success rate is lower than the 2-stage procedure. [12]
  • Early stages of PJI may respond to simple debridement, followed by 2-6wk of IV antibiotics and orally administrated antibiotics for up to 6mo; this approach may also be taken in patients with very high operative risk.
  • Indefinite suppressive antibiotic therapy is an option if the prosthesis cannot be removed (high operative risk) and there is an appropriate orally administrated antibiotic.
  • For prolonged antibiotic treatment of infections with all non-enterococcal streptococci, MSSA, MRSA, CoNS, and vancomycin-sensitive enterococci, dalbavancin should be considered owing to its weekly administration regimen: 1500 mg IV as loading dose followed by 500 mg IV weekly.{ref15-INVALID REFERENCE}

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