title: Factors related to outcome of early and delayed prosthetic joint infections.
abstract: In this prospective study, we evaluate the impact of adherence to a diagnostic and therapeutic protocol on prosthetic joint infections (PJI) diagnostic accuracy and outcome.
  
  
  METHODS
  Patients with early or delayed PJI referred over a 5-year period were included. Diagnosis was based on characteristic clinical signs, radiographic findings and microbiological evidence. Antibiotics were chosen on the basis of microbiological findings, and drugs active against methicillin-resistant staphylococci were administered if no microbiological evidence had been obtained.
  
  
  RESULTS
  Inclusion criteria were met in 159 cases (median age 64 years, males 45%). 56 were early infections and 103 delayed infections. Comorbidities were reported in 99 (62%) cases. Positive cultures were obtained in 122/159 (77%), coagulase-negative staphylococci were cultured in 20%, Staphylococcus aureus in 28%, and Pseudomonas aeruginosa in 7%. In early infections, cure rate after debridement and antibiotic therapy was 80%. In delayed infections, cure rate after two-stage exchange was 85%. Of 28 patients with delayed infection treated with antibiotics without surgery, only 8 (29%) infections were suppressed 48 weeks after treatment discontinuation. Rifampin afforded a better outcome.
  
  
  CONCLUSIONS
  Appropriate diagnostic and surgical procedures and microbiologically driven antibiotic therapy including rifampin are recommended to improve diagnostic accuracy and outcome.
authors: Department of Infectious Diseases, D. Cotugno Hospital, AORN Dei Colli, Naples, Italy. Electronic address: tizianascione@hotmail.com.
authors: T
authors: T
authors: Ascione
authors: Department of Infectious Diseases, D. Cotugno Hospital, AORN Dei Colli, Naples, Italy.
authors: P
authors: P
authors: Pagliano
authors: Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy.
authors: M
authors: M
authors: Mariconda
authors: Department of Orthopaedic Surgery, C.T.O. Hospital, AORN Dei Colli, Naples, Italy.
authors: R
authors: R
authors: Rotondo
authors: Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy.
authors: G
authors: G
authors: Balato
authors: Department of Orthopaedic Surgery, Sarno Hospital, Sarno, Italy.
authors: A
authors: A
authors: Toro
authors: Department of Orthopaedic Surgery, "S. Michele" Clinic, Maddaloni, Italy.
authors: V
authors: V
authors: Barletta
authors: Department of Microbiology, AORN Dei Colli, Naples, Italy.
authors: M
authors: M
authors: Conte
authors: Department of Infectious Diseases, University of Salerno, Italy.
authors: S
authors: S
authors: Esposito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015897:Comorbidity; D003428:Cross Infection / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D003646:Debridement; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000628:therapy*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007595:Joint Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D053208:Kaplan-Meier Estimate; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D013582:Synovial Fluid / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Diagnosis; Infection; Prosthetic joint infections; Surgical implant; Treatment