Periprosthetic infection due to resistant staphylococci: serious problems on the horizon.
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.
Parvizi
Javad
J
Department of Orthopedic Surgery, Rothman Institute of Orthopedics at Thomas Jefferson University Hospital, 925 Chestnut St, Philadelphia, PA 19107, USA. parvj@rothmaninstitute.com
Azzam
Khalid
K
Ghanem
Elie
E
Austin
Matthew S
MS
Rothman
Richard H
RH
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*