Methicillin-resistant Infection after Hip and Knee Replacement: Reason to Change Practice?

Abstract

Infection after a primary total-joint replacement can be devastating. If the infecting organism is meth-icillin resistant, the chance of successful eradication of the infection is considerably decreased. What is more concerning is that these organisms are becoming increasingly common in periprosthetic joint infection. We have reviewed the literature and have outlined the effectiveness of single- and two-stage treatment regimens for this difficult problem. We have also looked at the screening and decolonisation methods that have been implemented in an attempt to decrease the risk of surgical site infections. Lastly, we outline our recommendations on how we should tackle this emerging and difficult problem that is affecting the orthopaedic world.

Analysis of Causative Microorganism in 248 Primary Hip Arthroplasties Revised for Infection: A Study Using the NJR Dataset

“…In combination with patient and surgical factors, the outcome following revision arthroplasty for PJI is influenced by the ability to isolate organism(s) at time of surgery, the virulence of such an organism and its antimicrobial sensitivity profile (6, 10, 13-14-15-16-17). PJI is a rare event and as such the ability to acquire cases and surgical experience is restricted.…”

Microorganisms responsible for periprosthetic knee infections in England and Wales

“…Periprosthetic joint infection may be associated with a single organism or multiple organisms. The host response, degree of soft tissue damage, host bone destruction and patient outcome are directly influenced by the infecting pathogen in addition to the surgical management [1, 9, 12, 13, 15, 20, 22]. Early isolation of an organism allows for appropriate surgical and antibiotic strategies.…”

Management of ACL Reconstruction Complicated by MRSA Osteomyelitis Requiring a Gastrocnemius Perforator Flap

“…However, they noted infection with MRSA as a major risk factor for failure of DAIR 24 . Similarly, Van Houwelingen Andrew et al summarized evidence for a potential shift in the treatment algorithm for total joint infections to favor immediate removal of the prosthesis, especially in the setting of methicillin-resistant organisms 25 . Given that our patient had already undergone 3 I&Ds, with over 1 month of culture-targeted antibiotic treatment for MRSA without resolution, we determined that hardware removal was imperative.…”