[Antimicrobial therapy of periprosthetic joint infection : Summary of AE guidelines (2026)]

Periprosthetic joint infections (PJI) are among the most severe and complex complications following joint arthroplasty and require a structured interdisciplinary treatment approach. In addition to an adequate surgical strategy, pathogen-directed and patient-specific anti-infective therapy plays a central role in successful management.

Based on a comprehensive literature review and current guidelines, followed by a structured consensus process within the interdisciplinary working group of the "German Society for Arthroplasty (Deutsche Gesellschaft für Endoprothetik e. V.)", available treatment options were evaluated and consensus recommendations for the anti-infective management of PJI were developed.

The cornerstone of PJI treatment is surgical management combined with an initial empiric followed by targeted antibiotic therapy. Staphylococci represent the most frequently identified pathogens, with the biofilm-active antibiotic rifampin playing a key role in their treatment. Fluoroquinolones are primarily used for infections caused by gram-negative pathogens but are also employed in combination with rifampin for staphylococcal infections. For other clinically relevant pathogen groups, differentiated consensus-based treatment recommendations were established. The recommended total duration of antibiotic therapy is generally approximately 12 weeks.

Anti-infective therapy represents a key component in the successful treatment of periprosthetic joint infections. An individualized therapeutic approach, tailored to the respective surgical treatment strategy, is essential.