JAC Advance Access published online on December 19, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh033
© 2003 by The British Society for Antimicrobial Chemotherapy
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Leading article
1 Orthopaedic Clinic and Division of Infectious Diseases,
Geneva University Hospital, 24 rue Micheli-du-Crest, 1211 Geneva
14, Switzerland; Division
of Infectious Diseases, Garches University Hospital, 104,
Boulevard R. Poincaré, 92380 Garches, France
* Corresponding author. E-mail: daniel.lew{at}hcuge.ch.
The most commonly used therapy for prosthetic joint
infection is a two-stage prosthetic exchange separated by 6 weeks
of intravenous antibiotic therapy. This often results in long periods
of hospitalization, morbidity, severe functional impairment and
sometimes increased mortality. Therefore novel and challenging therapeutic
approaches have been attempted, particularly in hip prosthetic infection.
This includes, whenever possible, according to the type of microorganism,
antibacterial susceptibility and clinical presentation (including age
and comorbidities): (i) less aggressive surgical techniques (debridement
and prosthesis retention, or re-implantation with a single-stage
exchange arthroplasty); and (ii) antibiotic combinations active
against biofilm-associated bacteria, including rifampicin (particularly
with quinolones) with excellent bio-availability which allow prolonged
and efficient oral therapy.
Keywords: total joint infection, exchange prosthesis,
one-stage prosthetic reimplantation, two-stage prosthetic reimplantation
Trends in the treatment of orthopaedic prosthetic
infections
2 Orthopaedic Clinic, Geneva University Hospital, 24 rue Micheli-du-Crest, 1211 Geneva
14, Switzerland
3 Division of Infectious Diseases,
Geneva University Hospital, 24 rue Micheli-du-Crest, 1211 Geneva
14, Switzerland;
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