Risk factors associated with acute hip prosthetic joint infections and outcome of treatment with a rifampinbased regimen

Abstract

Background and purpose Acute prosthetic infection is a serious problem. We report factors related to the incidence of acute infection and results of combined joint debridement and prolonged rifampicin-based antibiotic therapy.Patients and methods Between 1998 and 2004, 14 acute infections occurred after 819 primary hip arthroplasties. The association between patient-related and surgical factors and the risk of infection were analyzed. Infections were treated with multiple joint lavage, debridement, 2 weeks of antibiotic therapy, and then oral antibiotics for a minimum of 6 months.Results There was a correlation between having a body mass index (BMI) of ≥ 30, and also more than 2 co-morbidities, and an increased risk of infection. Diabetes was a potential risk factor. Following our regime of treatment, 11 of 14 patients retained their prosthesis. 2 of 3 who required resection arthroplasty underwent successful staged revision, while the third patient had no further surgery because of being deemed unfit.Interpretation Primary joint replacement was salvaged in 11 of 14 patients. When successful re-implantation was included, 13 of 14 patients had a mobile prosthetic joint without further infection.

Risk factors associated with acute hip prosthetic joint infections and outcome of treatment with a rifampin‐based regimen

“…Indeed, in only 4 of the 7 patients with single or mixed MRSA infection could the prosthesis be successfully retained. Taken together, the statement of Choong et al (2007) that debridement with retention "may be suitable for patients who are not fit for major revision surgery (and) for those who decline further major surgery" is not based on our treatment concepts. Because Choong et al (2007) highlight the influence of our work on their treatment concept, we would like to emphasize the mentioned differences.…”

“…In their recent publication, Choong et al (2007) reported the outcome of a treatment protocol for total hip arthroplastyassociated infections (THIs), including debridement with retention and prolonged rifampin-based therapy. Since the authors refer to our treatment concepts, we would like to call attention to the fact that their retrospective study (Choong et al 2007) clearly used different criteria to select patients for retention of the implant than were described in our algorithm . Moreover, the duration of antimicrobial treatment reveals fundamental divergences from our approach.…”

“…The latter treatment option should be limited to patients in a bad general condition who are unable to undergo further surgery. Since Choong et al (2007) reported that 11 of 14 patients were treated with antibiotics for a median duration of 20 months (range 12 to indefinite), they obviously used a concept of suppression and not one of cure. Therefore, the characteristics of their patients should be analyzed.…”

“…The time to diagnosis of infection, described by Choong et al (2007) ranged from 5 to 105 days. Moreover, the treatment protocol was also applied in patients with wound discharge (i.e.…”

Prosthetic Joint Infections

“…[4,[6][7][8][9][10][11][12][13][14] Once an infection is diagnosed, a number of therapeutic approaches may be adopted. The selection of a particular approach depends on host factors (age, baseline mobility, comorbidities, etc.…”