title: Is prolonged systemic antibiotic treatment essential in two-stage revision hip replacement for chronic Gram-positive infection?
abstract: When using a staged approach to eradicate chronic infection after total hip replacement, systemic delivery of antibiotics after the first stage is often employed for an extended period of typically six weeks together with the use of an in situ antibiotic-eluting polymethylmethacrylate interval spacer. We report our multi-surgeon experience of 43 consecutive patients (44 hips) who received systemic vancomycin for two weeks in combination with a vancomycin- and gentamicin-eluting spacer system in the course of a two-stage revision procedure for deep infection with a median follow-up of 49 months (25 to 83). The antibiotic-eluting articulating spacers fractured in six hips (13.9%) and dislocated in five patients (11.6%). Successful elimination of the infecting organisms occurred in 38 (92.7%) of 41 hips with three patients developing superinfection with a new organism. We conclude that prolonged systemic antibiotic therapy may not be essential in the two-stage treatment of a total hip replacement for Gram-positive infection, provided that a high concentration of antibiotics is delivered locally using an antibiotic-eluting system.
authors.affiliation: Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, UK. jpwhittaker1@gmail.com
authors.forename: J P
authors.initials: JP
authors.lastname: Whittaker
authors.forename: R E
authors.initials: RE
authors.lastname: Warren
authors.forename: R S
authors.initials: RS
authors.lastname: Jones
authors.forename: P A
authors.initials: PA
authors.lastname: Gregson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D003646:Debridement / Q000379:methods; D004333:Drug Administration Routes; D004359:Drug Therapy, Combination; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006622:Hip Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D014640:Vancomycin