Optimal diagnosis, prevention, and management of periprosthetic joint infection

Figures & data

Table 1 Frequent and important risk factors for prosthetic joint infection

Preoperative	Intraoperative	Postoperative
Obesity and/or poor nutrition	Simultaneous bilateral arthroplasty	Remote infection
Diabetes mellitus	Lack of prophylactic antibiotic	Improper dressing
Immune suppression	Cement without antibiotic	Hematoma
Body carriage with Staphylococcus aureus	Duration of surgery >2 hours	Continuous wound discharge
Rheumatoid arthritis	Contaminated or dirty surgical site and skin ulcers	Prolonged hospital stay
Previous surgery in the same joint and history of joint infection History of joint infection Smoking Preoperative anemia Skin ulcers	Concomitant remote infection	Dehiscence

Table 2 Main recommended antibiotics according to the pathogen of prosthetic joint infections (personal opinions of the authors coupled to international recommendations)

Pathogens	Parenteral	Oral antibiotic	Alternative oral regimens
Staphylococcus aureus and coagulase-negative	Flucloxacillin 4×2 g Cefuroxime 3×1.5 g	Ciprofloxacin 2×750 mg Levofloxacin 2×500 mg	Clindamycin 3×600 mg Cotrimoxazole 3× double-strength
staphylococci (methicillin-sensitive)	Cefazolin 3×2 g Combined with rifampin 1x600 mg if implant in place	Combined with rifampin 1×600 mg if implant in place	Combined with rifampin 1×600 mg if implant in place
Staphylococcus aureus and coagulase-negative staphylococci (methicillin-resistant)	Vancomycin 2×1 g Daptomycin 1×6–8 mg/kg Combined with rifampin 1×600 mg if implant in place	Fucidin acid 3×500 mg Minocycline 2×100 mg Doxycycline 2×100 mg Linezolid 2×600 mg Combined with rifampin 1×600 mg if implant in place	Clindamycin 3×600 mg Cotrimoxazole 3× double-strength Combined with rifampin 1×600 mg if implant in place
Streptococci	Penicillin 6×3 million units	Clindamycin 3×600 mg	Amoxicillin 3×1 g
Enterococci	Penicillin 6×3 million units Vancomycin 2×1 g	Amoxicillin 3×1 g	Linezolid 2×600 mg
Enterobacteriaceae	Cefuroxime 3×1.5 g Amoxicillin/clavulanate 3×1.2 g	Ciprofloxacin 2×750 mg Levofloxacin 2×500 mg	Cotrimoxazole 3× double-strength
Gram-negative, nonfermenting rods such as Pseudomonas spp.	Ceftazidim 3×2 g Cefepime 2×2 g Ertapenem 1×1 g	Ciprofloxacin 2×750 mg	No oral alternatives to ciprofloxacin in most cases
Anaerobes	Amoxicillin/clavulanate 3×1.2 g Metronidazole 3×500 mg	Metronidazole 3×500 mg	Amoxicillin/clavulanate 3×1g