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Control/Tracking Number: ICAAC07-A-3155-ASM
Activity: Abstract
Current Date/Time: 5/6/2007 3:33:55 PM
Characteristics and Outcomes of Prosthetic Joint Infections at the Hines VA Hospital:
epidemiologic, clinical and microbiological aspects
Author Block: B. AL NEMR, C. JANOWAK, J. R. LENTINO;
Edward Hines Jr. VA Hosp., Hines, IL.
Abstract: Background: Prosthetic joint infections (PJIs) of total knee arthroplasty (TKA) and total hip
arthroplasty (THA) account for substantial morbidity and cost. Debate exists regarding the optimal
treatment strategy particularly for debridement and retention (DAR).Objectives: to define the
epidemiology, microbiology, treatment methods (Removal vs DAR) and outcomes for each modality.
Methods: A retrospective chart review. Data collected included: demographics, type of infection, location,
symptoms and their duration, pathogens, diagnostic procedure, antimicrobial (ABX) and surgical therapy,
duration of therapy and clinical outcome
Results: 69 patients with PJIs were identified between January 2001 and December 2005, of these, 37
were reviewed (49% TKA and 24% THA, 26% other). Median age was 69. Osteoarthritis was an
underlying pathology in 75%. PJIs were early 56%, late 14% and delayed in 30%. Pain and drainage were
the most common symptoms. Staphylococcus aureus (SA) was the pathogen in 43%, of which 56% were
MRSA, Coagulase-negative staphylococcus (CONS) in 35%, other gram positive bacteria 16%, gram
negative bacteria in 8%, Candida parapsilosis in 5%. 70% were treated with DAR, 24% with removal and
6% ABX only. DAR was done in 67% of early infections, in 60% of late infections and in 54% in delayed
PJIs. Success rate (SR) was 68% for all patients with a 3 year follow up, 78% for removal and 65% for
DAR. Vancomycin was used in 56.7% with SR of 62%, ceftriaxone in 19% with SR of 86% and
cefazolin in 19% with SR of 57%. (35%) received no suppressive ABX. Median duration of intravenous
ABX was 47 days and for suppressive ABX was 142 days. SA was the pathogen in 6/7 who failed DAR
and in 6/17 who were cured by RAD (P< 0.02). CONS PJIs were cured with RAD in 7/17 and failed in
0/7 (P<0.05).
Conclusions: SA was the main pathogen with MRSA as a majority. More people were treated with DAR
than removal with equivalent outcomes. Presence of SA was associated with failure.
:
Category (Complete): K
Keyword (Complete): epidemiology ; bacteria ; Outcomes ; Prosthetic Joint Infections, Veterans
population
Additional Information (Complete):
I do NOT have any off-label use(s) to disclose. : True
