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Oral antibiotics are effective for highly resistant hip arthroplasty infections.

Authors :
Cordero-Ampuero J
Esteban J
García-Cimbrelo E
Source :
Clinical orthopaedics and related research [Clin Orthop Relat Res] 2009 Sep; Vol. 467 (9), pp. 2335-42. Date of Electronic Publication: 2009 Mar 31.
Publication Year :
2009

Abstract

Infected arthroplasties reportedly have a lower eradication rate when caused by highly resistant and/or polymicrobial isolates and in these patients most authors recommend intravenous antibiotics. We asked whether two-stage revision with interim oral antibiotics could eradicate these infections. We prospectively followed 36 patients (mean age, 71.8 years) with late hip arthroplasty infections. Combinations of oral antibiotics were prescribed according to cultures, biofilm, and intracellular effectiveness. The minimum followup was 1 year (mean, 4.4 years; range, 1-12 years). We presumed eradication in the absence of clinical, serologic, and radiographic signs of infection. Infection was eradicated in all 13 patients with highly resistant bacteria who completed a two-stage protocol (10 with methicillin-resistant Staphylococci) and in eight of 11 patients treated with only the first stage (and six of nine with methicillin-resistant Staphylococci). Infection was eradicated in six of six patients with polymicrobial isolates (of sensitive and/or resistant bacteria) who completed a two-stage protocol and in five of seven with polymicrobial isolates treated with only the first surgery. The Harris hip score averaged 88.1 (range, 70-98) in patients who underwent reimplantation and 56.8 (range, 32-76) in patients who underwent resection arthroplasty. Long cycles of combined oral antibiotics plus a two-stage surgical exchange appear a promising alternative for infections by highly resistant bacteria, methicillin-resistant Staphylococci, and polymicrobial infections.

Details

Language :
English
ISSN :
1528-1132
Volume :
467
Issue :
9
Database :
MEDLINE
Journal :
Clinical orthopaedics and related research
Publication Type :
Academic Journal
Accession number :
19333670
Full Text :
https://doi.org/10.1007/s11999-009-0808-8