How to manage treatment failure in prosthetic joint infection

T. N. Peel, R. de Steiger

Research output: Contribution to journalReview ArticleOtherpeer-review

2 Citations (Scopus)

Abstract

Background: Management for prosthetic joint infections remains a challenging area for both infectious diseases and orthopaedic surgery, particularly in the setting of treatment failure. This is compounded by a lack of level 1 evidence to guide approaches. The optimal management of prosthetic joint infections requires a multi-disciplinary approach combined with shared decision making with the patient. Aims: This article describes the approach to prosthetic joint infections in the setting of treatment failure. Sources: Narrative review based on literature review from PubMed. There was no time limit on the studies included. In addition, the reference list for included studies were reviewed for literature saturation with manual searching of clinical guidelines. Management approaches described incorporate evidence- and eminence-based recommendations from expert guidelines and clinical studies, where applicable. Content: The surgical and antimicrobial approaches for prosthetic joint infections are described for first-line treatment of prosthetic joint infections and approaches in the event of treatment failure. Management approaches are based on an understanding of the role the biofilm plays in the pathogenesis of prosthetic joint infections. The management of these infections aims to fulfil two key goals: to eradicate the biofilm-associated microorganisms and, to maintain a functional joint and quality of life. In treatment failure, these goals are not always feasible, and the role of the multi-disciplinary team and shared-decision making are prominent. Implications: Prosthetic joint surgery is a high-volume surgery, and the demand for this surgery is continually increasing. With this, the number of infections requiring expert care will also increase. Eminence-based management approaches have been established to guide treatment failure until knowledge gaps in optimal management are addressed by well-designed, clinical trials.

Original languageEnglish
Pages (from-to)1473-1480
Number of pages8
JournalClinical Microbiology and Infection
Volume26
Issue number11
DOIs
Publication statusPublished - 1 Nov 2020

Keywords

  • Antimicrobial approach
  • Biofilm
  • Multi-disciplinary team
  • Prosthetic joint infection
  • Surgical approach
  • Treatment failure

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