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Guiding empirical antibiotic therapy in orthopaedics: The microbiology of prosthetic joint infection managed by debridement, irrigation and prosthesis retention.
J Infect 2007; 55(1):1-7JI

Abstract

OBJECTIVES

This study describes the microbiological spectrum of prosthetic joint infection (PJI) managed by debridement, washout and retention and so guides the choice of empirical antibiotics within this patient group.

METHODS

We performed a retrospective review of all patients admitted to our specialist tertiary unit for PJI who were managed with debridement and irrigation or arthroscopic washout of infected prosthetic joints between 1st January 1998 and 30th April 2003. Clinical and microbiological data sets were analysed using the Access database.

RESULTS

One hundred and twelve patients met the criteria for inclusion. 69% received their surgical intervention in the first three months after implantation ('early') and 21% after 12 months. Overall the most frequently isolated organisms were coagulase negative staphylococci (47% patients) and methicillin-sensitive Staphylococcus aureus (MSSA, 44% patients). 8% grew methicillin-resistant Staphylococcus aureus (MRSA) and 7% grew anaerobes. Most Gram-negative isolates were resistant to cefuroxime; all were sensitive to meropenem. Eighty-six percent of polymicrobial cultures occurred in early infections when 47% of patients grew more than one organism. MSSA was the most frequently isolated organism at all time points.

CONCLUSIONS

Most infections involved staphylococci. MRSA was infrequently isolated. Most polymicrobial infections occurred in early infection. A high rate of resistance to cephalosporins among Gram-negative organisms justifies the use of a broader agent such as a carbapenem in the early empirical antibiotic regime for PJI.

Authors+Show Affiliations

Department of Microbiology and Infectious Disease, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK. ed@moran.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17343916

Citation

Moran, E, et al. "Guiding Empirical Antibiotic Therapy in Orthopaedics: the Microbiology of Prosthetic Joint Infection Managed By Debridement, Irrigation and Prosthesis Retention." The Journal of Infection, vol. 55, no. 1, 2007, pp. 1-7.
Moran E, Masters S, Berendt AR, et al. Guiding empirical antibiotic therapy in orthopaedics: The microbiology of prosthetic joint infection managed by debridement, irrigation and prosthesis retention. J Infect. 2007;55(1):1-7.
Moran, E., Masters, S., Berendt, A. R., McLardy-Smith, P., Byren, I., & Atkins, B. L. (2007). Guiding empirical antibiotic therapy in orthopaedics: The microbiology of prosthetic joint infection managed by debridement, irrigation and prosthesis retention. The Journal of Infection, 55(1), pp. 1-7.
Moran E, et al. Guiding Empirical Antibiotic Therapy in Orthopaedics: the Microbiology of Prosthetic Joint Infection Managed By Debridement, Irrigation and Prosthesis Retention. J Infect. 2007;55(1):1-7. PubMed PMID: 17343916.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Guiding empirical antibiotic therapy in orthopaedics: The microbiology of prosthetic joint infection managed by debridement, irrigation and prosthesis retention. AU - Moran,E, AU - Masters,S, AU - Berendt,A R, AU - McLardy-Smith,P, AU - Byren,I, AU - Atkins,B L, Y1 - 2007/03/06/ PY - 2006/11/22/received PY - 2007/01/19/revised PY - 2007/01/19/accepted PY - 2007/3/9/pubmed PY - 2007/8/22/medline PY - 2007/3/9/entrez SP - 1 EP - 7 JF - The Journal of infection JO - J. Infect. VL - 55 IS - 1 N2 - OBJECTIVES: This study describes the microbiological spectrum of prosthetic joint infection (PJI) managed by debridement, washout and retention and so guides the choice of empirical antibiotics within this patient group. METHODS: We performed a retrospective review of all patients admitted to our specialist tertiary unit for PJI who were managed with debridement and irrigation or arthroscopic washout of infected prosthetic joints between 1st January 1998 and 30th April 2003. Clinical and microbiological data sets were analysed using the Access database. RESULTS: One hundred and twelve patients met the criteria for inclusion. 69% received their surgical intervention in the first three months after implantation ('early') and 21% after 12 months. Overall the most frequently isolated organisms were coagulase negative staphylococci (47% patients) and methicillin-sensitive Staphylococcus aureus (MSSA, 44% patients). 8% grew methicillin-resistant Staphylococcus aureus (MRSA) and 7% grew anaerobes. Most Gram-negative isolates were resistant to cefuroxime; all were sensitive to meropenem. Eighty-six percent of polymicrobial cultures occurred in early infections when 47% of patients grew more than one organism. MSSA was the most frequently isolated organism at all time points. CONCLUSIONS: Most infections involved staphylococci. MRSA was infrequently isolated. Most polymicrobial infections occurred in early infection. A high rate of resistance to cephalosporins among Gram-negative organisms justifies the use of a broader agent such as a carbapenem in the early empirical antibiotic regime for PJI. SN - 1532-2742 UR - https://www.unboundmedicine.com/medline/citation/17343916/Guiding_empirical_antibiotic_therapy_in_orthopaedics:_The_microbiology_of_prosthetic_joint_infection_managed_by_debridement_irrigation_and_prosthesis_retention_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0163-4453(07)00019-9 DB - PRIME DP - Unbound Medicine ER -