[Treatment of acute infection of total or partial hip arthroplasty with debridement and oral chemotherapy].
OBJECTIVE
The suitable antibiotic(s) and duration of treatment for hip prosthesis acute infections (HPAIs) has not been clearly defined.


METHODS
We studied 32 patients whose HPAI was diagnosed within 2 months after surgery. All patients underwent debridement and samples were taken for culture purposes. Antibiotics were started and adjusted to the antibiogram. Ambulatory follow-up controls were carried out for more than 18 months after treatment had finished.


RESULTS
There were 16 cases of staphylococcal infection while it was streptococcal in 2 cases, enterococcal in 6 and due to gram-negative bacillus in 6 patients. In 2 patients, the causal microorganism could not be identified. Patients with an infection due to gram-positive cocci (other than enterococci) were administered an association of antibiotics including rifampicin for a mean 2.7 months period. Outcome was favorable in 100% valuable cases, after a mean follow-up of 20.7 months. Patients with enterococcal infections were treated with a glycopeptide or beta-lactams for a mean of 2.6 months; all them had a unfavorable outcome. Out of 6 infections due to gram-negative bacilli, 2 valuable cases had a favorable evolution.


CONCLUSIONS
HPAIs due to Staphylococcus sp. or Streptococcus sp. can be successfully treated by means of surgical debridement plus an antibiotic scheme that includes rifampicin for a maximum period of 3 months. It is necessary to analyze the effectiveness of new antibiotics or antibiotic associations in cases of enterococcal infections.
Soriano
Alex
A
Instituto Clínico de Enfermedades Infecciosas e Inmunología. Hospital Clínic Universitari. IDIBAPS. Barcelona. Spain. asoriano@clinic.ub.es
García
Sebastián
S
Ortega
Mar
M
Almela
Manel
M
Gallart
Xavier
X
Vila
Jordi
J
Sierra
Josep
J
Tomas
Xavier
X
Martínez
José Antonio
JA
Mensa
José
J
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001424:Bacterial Infections / Q000209:etiology / Q000628:therapy*; D003646:Debridement / Q000379:methods*; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D006801:Humans; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000628:therapy*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents