Consensus document on controversial issues in the diagnosis and treatment of prosthetic joint infections.
BACKGROUND
Joint replacement surgery has been on the increase in recent decades and prosthesis infection remains the most critical complication. Many aspects of the primary prevention and clinical management of such prosthesis infections still need to be clarified.


OBJECTIVE
The aim of this GISIG (Gruppo Italiano di Studio sulle Infezioni Gravi) working group - a panel of multidisciplinary experts - was to define recommendations for the following controversial issues: (1) Is a conservative surgical approach for the management of prosthetic joint infections effective? (2) Is the one-stage or the two-stage revision for the management of prosthetic joint infections more effective? (3) What is the most effective treatment for the management of prosthetic joint infections due to methicillin-resistant staphylococci? Results are presented and discussed in detail.


METHODS
A systematic literature search using the MEDLINE database for the period 1988 to 2008 of randomized controlled trials and/or non-randomized studies was performed. A matrix was created to extract evidence from original studies using the CONSORT method to evaluate randomized clinical trials and the Newcastle-Ottawa Quality Assessment Scale for case-control studies, longitudinal cohorts, and retrospective studies. The GRADE method for grading quality of evidence and strength of recommendation was applied.
Leone
Sebastiano
S
Divisione di Malattie Infettive, Ospedali Riuniti, Bergamo, Italy. sebastianoleone@yahoo.it
Borrè
Silvio
S
Monforte
Antonella d'Arminio
Ad
Mordente
Gennaro
G
Petrosillo
Nicola
N
Signore
Alberto
A
Venditti
Mario
M
Viale
Pierluigi
P
Nicastri
Emanuele
E
Lauria
Francesco N
FN
Carosi
Giampiero
G
Moroni
Mauro
M
Ippolito
Giuseppe
G
D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D006622:Hip Prosthesis / Q000382:microbiology; D006801:Humans; D007720:Knee Prosthesis / Q000382:microbiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D013210:Staphylococcus / Q000187:drug effects*; D016896:Treatment Outcome