Prosthetic Joint Infections

What do bacteria like to adhere to?

Foreign material and devices to form biofilms

Which bacteria is a classic example of a bacteria that adheres to foreign material and forms biofilms?

Staphylococcus aureus

Describe the clinical presentation of prosthetic joint infections (PJIs)

Local signs and symptoms around the prosthesis site

Drainage or sinus tract formation (may be purulent)

Inflammation/edema

Erythema

Pain

Describe the early infection of a PJI

1-3 months after prosthesis implantation

More acute clinical presentation (pain, erythema, drainage, edema)

More common to be more virulent organisms

Which bacteria is the most common in early infection of PJIs?

Staphylococcus aureus

Which bacteria are most common in delayed infection of PJIs?

Coagulase-negative Staphylococcus (ex: Staphylococcus epidermidis)

Cutibacterium acnes

Describe the surgical management of PJI

ALL PJI require surgical management by orthopedic surgeons

Determine if prosthesis should be retained or if prosthesis should be removed

What route of administration is typical for antibiotics treating PJI?

Antibiotics are typically administered IV

What is the duration of therapy for antibiotics treating PJI?

4-6 weeks of antibiotics

What should be added to PJI therapy if the prosthesis if debrided and RETAINED (one-stage exchange)?

ADD Rifampin for Staphylococcus spp. infections for biofilm penetration

What is the targeted antibiotic therapy for MRSA in PJI?

Vancomycin PLUS rifampin

What is the targeted antibiotic therapy for MSSA in PJI?

Cefazolin OR oxacillin/nafcillin PLUS rifampin