T Ascione1, P Pagliano2, M Mariconda3, R Rotondo4, G Balato3, A Toro5, V Barletta6, M Conte7, S Esposito8. 1. Department of Infectious Diseases, D. Cotugno Hospital, AORN Dei Colli, Naples, Italy. Electronic address: tizianascione@hotmail.com. 2. Department of Infectious Diseases, D. Cotugno Hospital, AORN Dei Colli, Naples, Italy. 3. Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy. 4. Department of Orthopaedic Surgery, C.T.O. Hospital, AORN Dei Colli, Naples, Italy. 5. Department of Orthopaedic Surgery, Sarno Hospital, Sarno, Italy. 6. Department of Orthopaedic Surgery, "S. Michele" Clinic, Maddaloni, Italy. 7. Department of Microbiology, AORN Dei Colli, Naples, Italy. 8. Department of Infectious Diseases, University of Salerno, Italy.
Abstract
UNLABELLED: In this prospective study, we evaluate the impact of adherence to a diagnostic and therapeutic protocol on prosthetic joint infections (PJI) diagnostic accuracy and outcome. PATIENTS AND METHODS: Patients with early or delayed PJI referred over a 5-year period were included. Diagnosis was based on characteristic clinical signs, radiographic findings and microbiological evidence. Antibiotics were chosen on the basis of microbiological findings, and drugs active against methicillin-resistant staphylococci were administered if no microbiological evidence had been obtained. RESULTS: Inclusion criteria were met in 159 cases (median age 64 years, males 45%). 56 were early infections and 103 delayed infections. Comorbidities were reported in 99 (62%) cases. Positive cultures were obtained in 122/159 (77%), coagulase-negative staphylococci were cultured in 20%, Staphylococcus aureus in 28%, and Pseudomonas aeruginosa in 7%. In early infections, cure rate after debridement and antibiotic therapy was 80%. In delayed infections, cure rate after two-stage exchange was 85%. Of 28 patients with delayed infection treated with antibiotics without surgery, only 8 (29%) infections were suppressed 48 weeks after treatment discontinuation. Rifampin afforded a better outcome. CONCLUSION: Appropriate diagnostic and surgical procedures and microbiologically driven antibiotic therapy including rifampin are recommended to improve diagnostic accuracy and outcome.
UNLABELLED: In this prospective study, we evaluate the impact of adherence to a diagnostic and therapeutic protocol on prosthetic joint infections (PJI) diagnostic accuracy and outcome. PATIENTS AND METHODS: Patients with early or delayed PJI referred over a 5-year period were included. Diagnosis was based on characteristic clinical signs, radiographic findings and microbiological evidence. Antibiotics were chosen on the basis of microbiological findings, and drugs active against methicillin-resistant staphylococci were administered if no microbiological evidence had been obtained. RESULTS: Inclusion criteria were met in 159 cases (median age 64 years, males 45%). 56 were early infections and 103 delayed infections. Comorbidities were reported in 99 (62%) cases. Positive cultures were obtained in 122/159 (77%), coagulase-negative staphylococci were cultured in 20%, Staphylococcus aureus in 28%, and Pseudomonas aeruginosa in 7%. In early infections, cure rate after debridement and antibiotic therapy was 80%. In delayed infections, cure rate after two-stage exchange was 85%. Of 28 patients with delayed infection treated with antibiotics without surgery, only 8 (29%) infections were suppressed 48 weeks after treatment discontinuation. Rifampin afforded a better outcome. CONCLUSION: Appropriate diagnostic and surgical procedures and microbiologically driven antibiotic therapy including rifampin are recommended to improve diagnostic accuracy and outcome.
Authors: M Mussa; T Manciulli; M Corbella; B Mariani; P Cambieri; N Gipsz; L Scudeller; D M Abbott; E Brunetti; M Mosconi; F Benazzo; P Orsolini Journal: Musculoskelet Surg Date: 2020-01-28
Authors: Tiziana Ascione; Giovanni Balato; Massimo Mariconda; Francesco Smeraglia; Andrea Baldini; Cristiano De Franco; Giuseppe Pandolfo; Roberta Siciliano; Pasquale Pagliano Journal: Clin Orthop Relat Res Date: 2021-09-01 Impact factor: 4.755
Authors: H Scheper; L M Gerritsen; B G Pijls; S A Van Asten; L G Visser; M G J De Boer Journal: Open Forum Infect Dis Date: 2021-07-01 Impact factor: 3.835