Low relapse with oral antibiotics and two-stage exchange for late arthroplasty infections in 40 patients after 2–9 years

Abstract

Background and purpose Exchange surgery in late arthroplasty infection is directed against bacteria adhering to implants. Therapies based on antibiotics that are effective intracellularly have been proposed recently. We have combined both strategies to improve the cure rate.Methods 40 consecutive patients (16 hips, 24 knees) were diagnosed with late arthroplasty infection. The organisms isolated were 35 Staphylococcus, 19 of which were methicillin-resistant, 4 Enterococcus, 6 Gram-negative bacilli, and 4 Corynebacterium. The infections were managed by a combined therapy consisting of two-stage exchange surgery and two oral intracellularly-effective antibiotics. The antibiotics were selected according to bacterial sensitivity and intracellular and biofilm effectiveness. Second re-implantation surgery was delayed until clinical and analytical normalization. Patients were in hospital for only 1 week after each surgery, and were followed up prospectively on an outpatient basis (2-9 years). Cure of the infection was defined as absence of clinical, serological, and radiographic signs of infection during the whole follow-up.Results The infection was resolved in 38/40 patients (15/16 hips and 23/24 knees).Interpretation Oral antibiotics that are effective intracellularly in combination with two-stage exchange surgery is a promising alternative for treating late arthroplasty infections. Oral antibiotics shorten hospitalization and reduce patient discomfort.

Oral Antibiotics are Effective for Highly Resistant Hip Arthroplasty Infections

“…Polymicrobial infections have been less studied [14,18,20]. A very low risk of recurrence (ranging from 0% to 6%) [6,22] has been communicated with oral antibiotics plus two-stage surgery in chronic infections. Our purposes were to determine whether oral antibiotics would eradicate hip arthroplasty infections caused by highly resistant bacteria, methicillin-resistant Staphylococci, or polymicrobial isolates and to determine the functional outcomes of patients treated for these infections.…”

“…Alternative treatments with long cycles of oral antibiotics have been recently proposed [1,4,6,14,23,26], but some of these papers report a mixture of chronic and acute infections [1,26] and/or results with prosthesis retention 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.…”

“…Several papers suggest a low risk of recurrence (ranging from 0% to 6%) [6,22] with oral antibiotics plus two-stage surgery in chronic infections. A protocol based on oral antibiotics would allow treatment on an outpatient basis, short hospital stays, cost savings, and improved quality of life for patients [6].…”

Results after Late Polymicrobial, Gram-negative, and Methicillin-resistant Infections in Knee Arthroplasty

“…Immediately after harvesting, these samples were placed in a sterile container and sent to a microbiology laboratory within 30 minutes of acquisition and within 60 minutes were processed according to commonly accepted protocols. The samples were inoculated onto the following media: Tryptic soy 5% sheep blood agar, Chocolate agar, McConkey agar, and Schaedler 5% sheep blood agar [6]. Microbiological cultures in the five patients without surgery were obtained from their fistula and/or joint aspiration.…”

Evaluation of Quantitative Analysis of Cultures from Sonicated Retrieved Orthopedic Implants in Diagnosis of Orthopedic Infection

“…Clinical diagnosis of prosthetic infection was based on the standard preoperative and intraoperative signs associated with orthopedic implant infection: fistula, purulent discharge from the wound, intraoperative identification of periprosthetic purulence and/or a sinus tract communicating with the prosthesis, laboratory findings (maintained elevation of C-reactive protein and erythrocyte sedimentation rate), radiological signs, and/or gamma scan findings (2,9,17).…”