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Antimicrobial Management Strategies for Multidrug-Resistant Gram-Positive Prosthetic Device Infections

Burcu Isler1, Peter Simos2, Victoria Grey3

  • 1Department of Infectious Diseases, Gold Coast University Hospital, 1 Hospital Boulevard, Southport 4215, Gold Coast, QLD, Australia; Faculty of Health, Medicine & Behavioural Sciences, University of Queensland Centre for Clinical Research, Brisbane, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Australia.

Infectious Disease Clinics of North America
|December 11, 2025
PubMed

Insights

Managing multidrug-resistant (MDR) gram-positive prosthetic device infections requires surgery and antibiotics. Device removal is often key, with vancomycin a primary treatment, and newer drugs allowing outpatient care.

Area of Science:

  • Infectious Diseases
  • Medical Microbiology
  • Surgical Infections

Background:

  • Prosthetic device infections (PDIs) caused by multidrug-resistant (MDR) gram-positive bacteria present complex clinical challenges.
  • Key pathogens include methicillin-resistant staphylococci, ampicillin-resistant enterococci, vancomycin-resistant enterococci, and MDR Corynebacterium species.

Purpose of the Study:

  • To review current management strategies for PDIs caused by specific MDR gram-positive bacteria.
  • To highlight the interplay between surgical intervention and antimicrobial therapy.

Main Methods:

  • Literature review of management strategies for PDIs.
  • Analysis of antimicrobial options and surgical considerations.

Main Results:

  • Successful management necessitates a combined approach of surgical intervention and appropriate antimicrobial therapy.
  • Device removal is frequently essential for successful treatment outcomes.
  • Vancomycin is a cornerstone antimicrobial, while agents like dalbavancin offer outpatient treatment possibilities.
  • Linezolid use requires monitoring for toxicity during extended therapy.

Conclusions:

  • Surgical approach significantly influences outcomes, often more than antimicrobial choice alone.
  • Coordinated multidisciplinary care is critical for optimizing PDI management.
  • Emerging therapies provide new avenues for treating challenging PDI cases.
Keywords:
Antibiotic resistanceMethicillin-resistant staphylococciMultidrug-resistant organismsProsthetic device infectionsProsthetic joint infection

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