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Related Experiment Video

Updated: Jan 10, 2026

Knee Arthrocentesis in Adults
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Infected total knee arthroplasty: could cotrimoxazole be the answer?

Maria Inês Coutinho1, Teresa Almeida2,3, Fábia Silva4

  • 1Faculdade de Medicina da Universidade do Porto, Rua Doutor Plácido da Costa, Porto, 4200-450, Portugal. up201807637@up.pt.

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
|November 20, 2025
PubMed
Summary

For prosthetic joint infections after knee replacement, Staphylococcus species are common. Vancomycin is effective for acute infections, while Cotrimoxazole shows promise for chronic cases, guiding empirical antibiotic choice.

Keywords:
AntibioticEmpirical treatmentPeriprosthetic joint infectionSusceptibilityTotal knee arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Microbiology

Background:

  • Prosthetic joint infection (PJI) is a significant complication following total knee arthroplasty (TKA).
  • Understanding the microbiological landscape and antibiotic susceptibility is crucial for effective management.
  • Differentiating between acute and chronic PJI is essential for treatment strategies.

Purpose of the Study:

  • To delineate the microbiological profile of acute and chronic PJI post-TKA.
  • To assess antibiotic susceptibility patterns for common PJI pathogens.
  • To inform the selection of appropriate empirical antibiotic therapies.

Main Methods:

  • Retrospective review of institutional data from 2021-2024.
  • Inclusion of patients undergoing reoperation for PJI after primary TKA.
  • Analysis of demographic data, microbiological results, and antimicrobial susceptibility testing.

Main Results:

  • Forty patients were included, with chronic PJI (> 6 weeks) being most prevalent (75%).
  • Gram-positive organisms predominated, with Staphylococcus aureus (24.2%), S. epidermidis (16.7%), and S. lugdunensis (13.6%) as leading pathogens.
  • Vancomycin demonstrated 100% susceptibility in all PJI cases. Cotrimoxazole showed 97% susceptibility against main pathogens in chronic infections.

Conclusions:

  • Empirical antibiotic choice for PJI should consider infection timing (acute vs. chronic).
  • Vancomycin is recommended as first-line empirical treatment for acute PJI.
  • Cotrimoxazole presents a viable alternative for chronic PJI due to low resistance rates, with de-escalation to targeted therapy advised post-culture.