Antibiotic use in prosthetic device infections

The incidence of prosthetic infections presenting to the emergency department is constantly increasing as the number of patients with prostheses grows. Our first duty as emergency physicians is to maintain a high index of suspicion for prosthetic infection in patients presenting with prosthetic dysfunction or fever. Optimal cultures must be obtained before instituting antimicrobial therapy. In stable patients, this may preclude starting antibiotics in the emergency department. The diversity of prosthetic infections and the need for accurate treatment in order to reduce the morbidity, mortality, and economic costs requires an in-depth knowledge of the microbiology and pharmacologic management of such infections. Except in the case of prosthetic heart valves, prophylactic antibiotics are rarely indicated and their use should be based on judicious clinical decision making.