title: Current antibiotic management of prosthetic joint infections in Italy: the 'Udine strategy'.
abstract: The rate of prosthetic joint infections followed and cured at our institution is constantly increasing, in line with epidemiological data from the recent literature. This is probably related to the greater number of knee and hip prostheses implanted every year. For intermediate and late infections, only the two-stage approach is applied, as this demonstrates the best outcome in our experience. Particular attention is paid to microbiological isolation of the pathogen: multiple samples of tissue are collected during the interventions, and kept in culture for a longer period of time than usual. Sonication of prosthetic devices is used to enhance the sensitivity and specificity of the microbiological cultures. Histological examination influences surgical choices either towards implantation of a new prosthesis or replacement of the spacer. An empirical antibiotic backbone of a glycopeptide/lipopeptide and rifampicin is chosen, due to the leading role of Gram-positive bacteria in this setting and the high incidence of methicillin resistance in our centre (>30%), followed by an antibiotic regimen containing linezolid. If specific risk factors are present, an anti-Gram-negative drug is added to the regimen. Duration of therapy depends upon the approach that is chosen, usually being 6 weeks when the prosthesis is removed. Despite at the moment being limited by its small sample size, data from our experience confirms that our empirical approach may represent a valid choice during the early phase of treatment, by keeping linezolid for a step-down therapy of shorter duration (4 weeks).
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy bassetti.matteo@aoud.sanita.fvg.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Cadeo
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Villa
authors.affiliation: Microbiology Unit, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Assunta
authors.initials: A
authors.lastname: Sartor
authors.affiliation: Orthopaedic Clinic, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Vanni
authors.initials: V
authors.lastname: Cainero
authors.affiliation: Orthopaedic Clinic, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Araldo
authors.initials: A
authors.lastname: Causero
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000628:therapy*; D004359:Drug Therapy, Combination / Q000379:methods; D006801:Humans; D007558:Italy; D008828:Microbiological Techniques / Q000379:methods; D010003:Osteoarthritis / Q000175:diagnosis / Q000628:therapy*; D010336:Pathology / Q000379:methods; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000628:therapy*; D013514:Surgical Procedures, Operative / Q000379:methods*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Staphylococcus; duration; hip; knee; treatment