OBJECTIVES: Antibiotic-loaded spacers may improve antimicrobial efficacy in two-stage revision of prosthetic joint infections, but they may also interfere in the course of infection. This prospective study of prosthetic joint infections managed with two-stage revision and antibiotic-loaded spacers (2004-09) analyzes case outcomes and proposes a second-stage culture interpretation scheme. METHODS: Second-stage infection was diagnosed upon second-stage cultures (synovial membranes, joint fluid, spacers), as either superinfection (≥2 samples, new organism) or persistence (≥1 samples, previously isolated organism). Isolated positive antibiotic-loaded spacers cultures were considered as colonizations. RESULTS: Of 42 patients, two had two prosthetic infections (n = 44): 25 knees, 19 hips. Spacers contained gentamicin (33), vancomycin (10) and aztreonam (1). Three patients (7%) with wound healing impairment required debridement and spacer exchange. The remainder underwent second-stage surgery as planned: 34 (77%) new arthroplasties, five arthrodeses, one resection arthroplasty and one permanent spacer. Of 18 cases (44%) with ≥1 positive sample, only four (10%) were second-stage infections. Fourteen antibiotic-loaded spacers cultures (34%) were positive. Four new prostheses (9%) supervened further infections: one by the organism isolated in the spacer, three by new bacteria. CONCLUSIONS: The findings of second-stage cultures show that the surgical site is frequently non-sterile at reimplantation. Isolated positive antibiotic-loaded spacer cultures usually have no clinical consequences, but together with tissue cultures they help to diagnose second-stage infections when clinical signs are absent.
OBJECTIVES: Antibiotic-loaded spacers may improve antimicrobial efficacy in two-stage revision of prosthetic joint infections, but they may also interfere in the course of infection. This prospective study of prosthetic joint infections managed with two-stage revision and antibiotic-loaded spacers (2004-09) analyzes case outcomes and proposes a second-stage culture interpretation scheme. METHODS: Second-stage infection was diagnosed upon second-stage cultures (synovial membranes, joint fluid, spacers), as either superinfection (≥2 samples, new organism) or persistence (≥1 samples, previously isolated organism). Isolated positive antibiotic-loaded spacers cultures were considered as colonizations. RESULTS: Of 42 patients, two had two prosthetic infections (n = 44): 25 knees, 19 hips. Spacers contained gentamicin (33), vancomycin (10) and aztreonam (1). Three patients (7%) with wound healing impairment required debridement and spacer exchange. The remainder underwent second-stage surgery as planned: 34 (77%) new arthroplasties, five arthrodeses, one resection arthroplasty and one permanent spacer. Of 18 cases (44%) with ≥1 positive sample, only four (10%) were second-stage infections. Fourteen antibiotic-loaded spacers cultures (34%) were positive. Four new prostheses (9%) supervened further infections: one by the organism isolated in the spacer, three by new bacteria. CONCLUSIONS: The findings of second-stage cultures show that the surgical site is frequently non-sterile at reimplantation. Isolated positive antibiotic-loaded spacer cultures usually have no clinical consequences, but together with tissue cultures they help to diagnose second-stage infections when clinical signs are absent.
Authors: Kevin L Garvin; Ryan E Miller; Todd M Gilbert; Anthony M White; Elizabeth R Lyden Journal: Clin Orthop Relat Res Date: 2018-02 Impact factor: 4.176
Authors: Eric Gomez-Urena; Rafael J Sierra; Kerryl E Greenwood-Quiantance; Melissa J Karau; James M Steckelberg; Robin Patel Journal: J Clin Microbiol Date: 2019-01-30 Impact factor: 5.948
Authors: Kevin Staats; Florian Sevelda; Alexandra Kaider; Christoph Böhler; Irene K Sigmund; Stephan E Puchner; Reinhard Windhager; Johannes Holinka Journal: Infection Date: 2017-10-24 Impact factor: 3.553