Management of bone and joint infections due to Staphylococcus aureus

Abstract

The clinical presentation, investigation, treatment and prevention of osteomyelitis, septic arthritis, and prosthetic joint infections due to Staphylococcus aureus are discussed in this review. It is difficult to make evidence-based recommendations on the treatment of these infections, as very little high quality clinical evidence exists. Experimental evidence, case series and published expert opinion are reviewed and used to suggest the preferred treatment options in each type of infection. A combination of prolonged intravenous antibiotic therapy and surgery is generally required for cure of S. aureus bone and joint infections. The current standard antibiotic therapy for these infections is an intravenous beta-lactam agent. Newer antibiotic approaches, such as use of fluoroquinolones and rifampicin are reviewed, as are newer surgical approaches, such as attempted salvage of infected prosthetic joints.

Staphylococcus aureus: visitando uma cepa de importância hospitalar

“…Algumas cepas de S. aureus podem sobreviver intracelularmente em osteoblastos, às vezes metabolicamente inativas, tornandose tolerantes à ação dos antibióticos. Além disso, o S. aureus pode formar biofilmes na superfície de materiais estranhos ao organismo, como cateteres endovenosos e próteses, que funcionam como locais protegidos contra a ação de antibió-ticos e do sistema imunológico do hospedeiro (13) .…”

Aggressive Early Débridement for Treatment of Acutely Infected Cemented Total Hip Arthroplasty

“…Then a second procedure is planned once control of infection is achieved with local and systemic antibiotics [35,36]. In acute infections, aggressive open débridement with or without exchange of mobile parts (femoral heads and acetabular inserts) and retention of the infected implant has been advocated for early or late infections with a short duration of symptoms, stable components, no evidence of immunosuppression, and overlying soft tissue and skin of good condition [12,42]. The aim of rapid intervention with thorough open débridement is to prevent the production of any biofilm by the infecting organism, paramount for a successful outcome [31].…”

“…Difficulties with this approach, however, include complete débridement of all dead or nonviable tissues and determination of the time of onset of infection and the point beyond which it is no longer reasonable to retain the implant. Davis [12] suggested up to 2 weeks for early infection and up to 72 hours for acute hematogenous, late infection, whereas Zimmerli et al [42] recommended a period of 3 weeks for both early and late infections. Long-term suppressive antibiotics are indicated when an operation is refused by the patient or is believed to be associated with an unacceptable risk in medically unfit patients, and salvage procedures such as Girdlestone arthroplasty and arthrodesis are considered in life threatening or intractable hip infections and when patient or limb viability is at risk [36].…”

Osteomyelitis: Identification and Management

“…Surgery can be indicated after failure of antibiotic treatment, or in case of chronic osteomyelitis with dead soft tissue or bone [30]. Surgical debridement removes the dead necrotic tissue.…”