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Periprosthetic infection due to resistant staphylococci: serious problems on the horizon
Javad Parvizi1, Khalid Azzam, Elie Ghanem
1Department of Orthopedic Surgery, Rothman Institute of Orthopedics at Thomas Jefferson University Hospital, 925 Chestnut St, Philadelphia, PA 19107, USA. parvj@rothmaninstitute.com
Unlabelled:
Prosthetic joint infections (PJI) caused by methicillin-resistant staphylococci represent a major therapeutic challenge. We examined the effectiveness of surgical treatment in treating infection of total hip or knee arthroplasty caused by methicillin-resistant staphylococcal strains and the variables influencing treatment success. One hundred and twenty-seven patients were treated at our institution between 1999 and 2006. There were 58 men and 69 women, with an average age of 66 years. Patients were followed for a minimum of 2 years or until recurrence of infection. Débridement and retention of the prosthesis was performed in 35 patients and resection arthroplasty in 92. Débridement controlled the infection in only 37% of cases whereas two-stage exchange arthroplasty controlled the infection in 75% of hips and 60% of knees. Preexisting cardiac disease was associated with a higher likelihood of failure to control infection in all treatment groups. Antibiotic-resistant Staphylococci continue to compromise treatment outcome of prosthetic joint infections, especially in patients with medical comorbidities. New preventive and therapeutic strategies are needed.
Level Of Evidence:
Level IV, therapeutic study.
Insights
Treating prosthetic joint infections (PJI) from methicillin-resistant staphylococci is challenging. Two-stage exchange arthroplasty offers better infection control than débridement for PJI, especially with comorbidities.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Medical Microbiology
Background:
- Prosthetic joint infections (PJI) caused by methicillin-resistant staphylococci present significant treatment difficulties.
- Effective management strategies for PJI are crucial for patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of surgical interventions for PJI caused by methicillin-resistant staphylococci.
- To identify factors influencing the success of PJI treatment in total hip and knee arthroplasty.
Main Methods:
- Retrospective analysis of 127 patients treated for PJI between 1999 and 2006.
- Comparison of outcomes between débridement and retention of prosthesis (35 patients) versus resection arthroplasty (92 patients).
- Minimum 2-year follow-up or until infection recurrence.
Main Results:
- Débridement and retention controlled infection in only 37% of cases.
- Two-stage exchange arthroplasty achieved infection control in 75% of hips and 60% of knees.
- Preexisting cardiac disease was linked to a higher failure rate across all treatment groups.
Conclusions:
- Antibiotic-resistant staphylococci significantly impact PJI treatment outcomes, particularly in patients with comorbidities.
- Two-stage exchange arthroplasty demonstrates superior efficacy in controlling PJI compared to débridement and retention.
- Novel preventive and therapeutic approaches are necessary to address the challenges posed by resistant staphylococcal infections in prosthetic joints.
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