title: The microbiology of the infected knee arthroplasty.
abstract: We describe the results of a retrospective analysis of patients with microbiologically proven infection, who underwent revision TKA between 1994 and 2008. Of the 121 patients included in the study, 61 (50%) were male and 60 (50%) were female. The mean age was 71 (range 42-88) years. The most common organisms identified were Coagulase negative Staphylococcus (CNS) (49%) and Staphylococcus aureus (SA) (13%). The prevalence of CNS appears to be increasing, while that of SA and other organisms is decreasing. Vancomycin and teicoplanin were the most effective antibiotics with overall sensitivity rates of 100% and 96%, respectively. The results of our theoretical model suggest that gentamicin combined with vancomycin is the most effective empirical regimen. Staphylococcal species are the most common organisms encountered in deep infection of the knee. Gentamicin combined with vancomycin offers the most comprehensive protection and potentially allows for infected knee arthoplasties to be treated with a one-stage procedure.
authors.affiliation: Centre for Hip Surgery, Wrightington Hospital, Wrightington, Wigan and Leigh NHS Trust, Appley Bridge, Wigan, Lancashire, UK. rnickinson@doctors.org.uk
authors.forename: R S J
authors.initials: RS
authors.lastname: Nickinson
authors.forename: T N
authors.initials: TN
authors.lastname: Board
authors.forename: A K
authors.initials: AK
authors.lastname: Gambhir
authors.forename: M L
authors.initials: ML
authors.lastname: Porter
authors.forename: P R
authors.initials: PR
authors.lastname: Kay
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003030:Coagulase / Q000378:metabolism; D004359:Drug Therapy, Combination; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007719:Knee Joint / Q000382:microbiology* / Q000473:pathology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012086:Reoperation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D013210:Staphylococcus / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D003030:Coagulase; D005839:Gentamicins; D014640:Vancomycin