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An update on surgical and antimicrobial therapy for acute periprosthetic joint infection: new challenges for the

Dolors Rodríguez-Pardo1, Carles Pigrau, Pablo S Corona

  • 1Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.

Expert Review of Anti-Infective Therapy
|January 13, 2015
PubMed

Insights

Early periprosthetic joint infection (PJI) management often involves debridement, antibiotics, and implant retention. However, optimal antibiotic selection and duration for these early PJI cases require further research and evidence.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Pharmacology

Background:

  • Periprosthetic joint infection (PJI) is a severe complication after arthroplasty.
  • Early PJI, occurring within the first year, can often be treated with debridement, antibiotics, and implant retention (DAIR).
  • Current evidence for optimal antibiotic strategies in DAIR for early PJI is limited.

Purpose of the Study:

  • To review the current understanding and evidence regarding antibiotic treatment for early PJI managed with DAIR.
  • To identify uncertainties and areas needing further research in antibiotic regimens for early PJI.

Main Methods:

  • Literature review focusing on studies related to early PJI management.
  • Analysis of existing recommendations and guidelines, including Zimmerli's algorithm.
  • Evaluation of evidence supporting specific antibiotic choices (e.g., rifampin, fluoroquinolones) and treatment parameters.

Main Results:

  • DAIR is a viable option for many early PJI cases meeting specific criteria.
  • Rifampin-containing regimens are suggested for gram-positive infections, and fluoroquinolones for gram-negative.
  • Significant uncertainties remain regarding optimal antibiotic duration, dosage, route, and combination therapy.

Conclusions:

  • While DAIR is a recognized approach for early PJI, the optimal antibiotic treatment remains unclear.
  • Further high-quality research is essential to establish evidence-based guidelines for antibiotic therapy in early PJI.
  • Current recommendations rely heavily on limited data, expert opinion, and experimental findings.

Keywords:
acute periprosthetic joint infectionantibiotic treatmentdebridementfluoroquinolonesrifampin

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