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🌱 來自: bacterial arthritis

Prosthetic joint infections

• ↑ risk in first 2 y s/p procedure;
• rate generally low (0.5-2.4%);
• risk factors include obesity, RA, immunocompromised state, steroids, & superficial surgical site infxn
• Staphylococci (coag negative & S. aureus) in >50%;
  • polymicrobial in 10-20%

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• Early (<3 mo s/p surgery) or delayed (3-24 mo) onset of sx from microbe typically acquired during implantation;
  • early w/ virulent (eg, MRSA) and delayed w/ less virulent organisms (eg, P. acnes, coag negative Staph) & more indolent presentation
• Late (>24 mo) onset typically related to secondary hematogenous seeding
• Diagnosis requires arthrocentesis; ESR & CRP (CRP Se 73-91%, Sp 81- 86%; NEJM 2009;361:787) can be helpful
• Requires prolonged abx (initial empiric regimen: vanc + 3rd/4th gen cephalosporin) for 6 wks (NEJM 2021;384:1991) & 2-stage joint replacement (retention a/w ~40% failure; CID 2013;56:182) or life-long suppressive abx. Consult ID & orthopedics.