title: An update on surgical and antimicrobial therapy for acute periprosthetic joint infection: new challenges for the present and the future.
abstract: Periprosthetic joint infection (PJI) is a devastating complication that can occur following any arthroplasty procedure. Approximately half of these infections develop within the first year after arthroplasty, mainly in the first 1 to 3 months. These infections are known as early PJI. It is widely accepted that many early PJIs can be successfully managed by debridement, irrigation, and prosthetic retention, followed by a course of biofilm-effective antibiotics (debridement, antibiotics, implant retention procedure), but candidate patients should meet the requirements set down in Zimmerli's algorithm. The best antibiotic regimen for acute PJI treated without implant removal remains uncertain. Rifampin-containing regimens, when feasible, are recommended in gram-positive infections, and fluoroquinolones in gram-negative cases. The duration, dosage, and administration route of antibiotics and the use of combined therapy are matters that requires further clarification, as the current level of evidence is low and most recommendations are based on experimental data, studies in small series, and expert experience.
authors.affiliation: Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Dolors
authors.initials: D
authors.lastname: Rodríguez-Pardo
authors.forename: Carles
authors.initials: C
authors.lastname: Pigrau
authors.forename: Pablo S
authors.initials: PS
authors.lastname: Corona
authors.forename: Benito
authors.initials: B
authors.lastname: Almirante
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018441:Biofilms / Q000187:drug effects*; D003646:Debridement; D020878:Device Removal; D024841:Fluoroquinolones / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007596:Joints; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000601:surgery*; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D012293:Rifampin
keywords: acute periprosthetic joint infection; antibiotic treatment; debridement; fluoroquinolones; rifampin