title: Periprosthetic infection due to resistant staphylococci: serious problems on the horizon.
abstract: Prosthetic joint infections (PJI) caused by methicillin-resistant staphylococci represent a major therapeutic challenge. We examined the effectiveness of surgical treatment in treating infection of total hip or knee arthroplasty caused by methicillin-resistant staphylococcal strains and the variables influencing treatment success. One hundred and twenty-seven patients were treated at our institution between 1999 and 2006. There were 58 men and 69 women, with an average age of 66 years. Patients were followed for a minimum of 2 years or until recurrence of infection. Débridement and retention of the prosthesis was performed in 35 patients and resection arthroplasty in 92. Débridement controlled the infection in only 37% of cases whereas two-stage exchange arthroplasty controlled the infection in 75% of hips and 60% of knees. Preexisting cardiac disease was associated with a higher likelihood of failure to control infection in all treatment groups. Antibiotic-resistant Staphylococci continue to compromise treatment outcome of prosthetic joint infections, especially in patients with medical comorbidities. New preventive and therapeutic strategies are needed.
  
  
  METHODS
  Level IV, therapeutic study.
authors.affiliation: Department of Orthopedic Surgery, Rothman Institute of Orthopedics at Thomas Jefferson University Hospital, 925 Chestnut St, Philadelphia, PA 19107, USA. parvj@rothmaninstitute.com
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
authors.forename: Khalid
authors.initials: K
authors.lastname: Azzam
authors.forename: Elie
authors.initials: E
authors.lastname: Ghanem
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Austin
authors.forename: Richard H
authors.initials: RH
authors.lastname: Rothman
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D015897:Comorbidity; D003646:Debridement / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*