title: A Standardized Regimen for the Treatment of Acute Postoperative Infections and Acute Hematogenous Infections Associated With Hip and Knee Arthroplasties.
abstract: Papers concerning the treatment of periprosthetic infections and acute hematogenous infections often concern inhomogeneous treatment concepts or low numbers of patients; this results in inconsistent rates of treatment success.
  
  
  
  Thirty-nine patients with early periprosthetic infections and 28 patients with acute hematogenous infections were treated with a homogeneous concept and followed with a mean period of 41.8 (24-132) months in order to investigate the success rate and influencing factors. All patients were treated with open surgical debridement, a revision of all removable components and irrigation with an antiseptic solution (octinedine). All patients received a systemic vancomycin/rifampicin antibiotic therapy until the microorganism causing the infection could be identified; a specific antibiotic therapy then followed until the end of the sixth week.
  
  
  
  This unified treatment regimen resulted in an overall success rate of 71.6%, an 82.1% success for early infections and 57.1% for acute hematogenous infections. Variables that influenced the recurrence of an infection were the timespan between revision and first appearance of symptoms (<2 days), the number of previous operations, the American Society of Anesthesiologists classification, and nicotine abuse.
  
  
  
  It appears that, in cases of early postoperative infection, a reproducibly high rate of success in retaining an implant can be achieved with this specific therapy regime if surgical intervention can be carried out within 2 days of first symptoms.
authors.affiliation: Clinic of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Markgröningen, Germany; Department of Orthopaedics, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Fink
authors.affiliation: Clinic of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Markgröningen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuster
authors.affiliation: Clinic of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Markgröningen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schwenninger
authors.affiliation: Service for Infectious Diseases, Clinical Microbiology and Infection Control, Hamburg, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Frommelt
authors.affiliation: Clinic of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Markgröningen, Germany.
authors.forename: Damian
authors.initials: D
authors.lastname: Oremek
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology; D002985:Clinical Protocols; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D012293:Rifampin
keywords: acute hematogenous infection; acute postoperative infection; debridement; irrigation; periprosthetic infection