Antimicrobial treatment of patients with a periprosthetic joint infection: basic principles

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Microbiology

Background:

• Periprosthetic joint infections (PJI) are challenging due to bacterial biofilms on implants.
• Bacteria in biofilms exhibit reduced metabolic activity, leading to antibiotic tolerance.
• Understanding biofilm dynamics is crucial for effective PJI treatment.

Purpose of the Study:

• To review the principles of antibiotic treatment for PJI.
• To explain the concept of biofilm-active antibiotics from in vitro and in vivo perspectives.
• To highlight clinical evidence for specific biofilm-active antibiotics in PJI.

Main Methods:

• Literature review focusing on biofilm formation in PJI.
• Analysis of in vitro and in vivo studies of biofilm-active antibiotics.
• Examination of clinical data on antibiotic efficacy in PJI.

Main Results:

• Rifampicin is effective against Gram-positive bacteria in PJI biofilms.
• Fluoroquinolones show efficacy against Gram-negative bacteria in PJI biofilms.
• Optimal treatment duration and transition to oral therapy are key considerations.

Conclusions:

• Biofilm-active antibiotics are essential for successful PJI treatment.
• Targeted antibiotic selection (e.g., rifampicin, fluoroquinolones) improves outcomes.
• Further research on optimal treatment durations and oral switch timing is warranted.