Prosthetic Joint Infection

Guidelines and Recommendations Update

Research output: Chapter in Book/Report/Conference proceedingChapter (Book)Otherpeer-review

Abstract

Joint replacement surgery is a modern success story with clear clinical and societal benefits; infection of the prosthesis is one of the most feared complications. The behaviour of microorganisms in the setting of prosthetic material and the role of biofilm dictate the approaches to diagnosis and management of these infections. Recognising the impact of patient-related factors, such as diabetes mellitus and obesity, on the development of infections is important.
Diagnosing infection requires application and interpretation of a number of investigations: no investigation has perfect sensitivity or specificity. A high index of suspicion for infection is key, especially in patients with painful joints. Suspicion of infection calls for routine serum inflammatory markers, aspiration of the index joint for assessment of the synovial fluid white cell count and neutrophil percentage, and synovial fluid culture. With revision surgery or arthrotomy for suspected or proven infection, collection of three tissue samples minimum for microbiological culture and histological assessment aids diagnosis. Sonicating the prosthesis and/or applying molecular polymerase chain techniques helps in culture-negative cases, including in patients recently exposed to antimicrobials. Newer tests such as alpha-defensin are promising but need further examination.
Management is contingent on acuity of presentation and organisms isolated. Debridement and implant retention strategies with administration of anti-biofilm agents are a reasonable strategy with acute infection with stable implant. Chronic infections require removal with or without reimplantation of a new prosthesis. Optimal duration of antimicrobial therapy remains under investigation.
Prevention targets optimisation of comorbid disease in patients undergoing joint replacement and minimising wound contamination during and after surgery. Recent WHO and CDC guidelines provide evidence-based recommendations for infection prevention following surgery, including in patients undergoing joint replacement.
Original languageEnglish
Title of host publicationProsthetic Joint Infections
EditorsTrisha Peel
Place of PublicationCham, Switzerland
PublisherSpringer
Pages247-256
Number of pages10
ISBN (Electronic)9783319652504
ISBN (Print)9783319652498
DOIs
Publication statusPublished - 2018

Cite this

Peel, T. N. (2018). Prosthetic Joint Infection: Guidelines and Recommendations Update. In T. Peel (Ed.), Prosthetic Joint Infections (pp. 247-256). Cham, Switzerland: Springer. https://doi.org/10.1007/978-3-319-65250-4_6
Peel, Trisha Nicole. / Prosthetic Joint Infection : Guidelines and Recommendations Update. Prosthetic Joint Infections. editor / Trisha Peel. Cham, Switzerland : Springer, 2018. pp. 247-256
@inbook{55e9a56f4d774090ab6fe8ae388d7740,
title = "Prosthetic Joint Infection: Guidelines and Recommendations Update",
abstract = "Joint replacement surgery is a modern success story with clear clinical and societal benefits; infection of the prosthesis is one of the most feared complications. The behaviour of microorganisms in the setting of prosthetic material and the role of biofilm dictate the approaches to diagnosis and management of these infections. Recognising the impact of patient-related factors, such as diabetes mellitus and obesity, on the development of infections is important.Diagnosing infection requires application and interpretation of a number of investigations: no investigation has perfect sensitivity or specificity. A high index of suspicion for infection is key, especially in patients with painful joints. Suspicion of infection calls for routine serum inflammatory markers, aspiration of the index joint for assessment of the synovial fluid white cell count and neutrophil percentage, and synovial fluid culture. With revision surgery or arthrotomy for suspected or proven infection, collection of three tissue samples minimum for microbiological culture and histological assessment aids diagnosis. Sonicating the prosthesis and/or applying molecular polymerase chain techniques helps in culture-negative cases, including in patients recently exposed to antimicrobials. Newer tests such as alpha-defensin are promising but need further examination.Management is contingent on acuity of presentation and organisms isolated. Debridement and implant retention strategies with administration of anti-biofilm agents are a reasonable strategy with acute infection with stable implant. Chronic infections require removal with or without reimplantation of a new prosthesis. Optimal duration of antimicrobial therapy remains under investigation.Prevention targets optimisation of comorbid disease in patients undergoing joint replacement and minimising wound contamination during and after surgery. Recent WHO and CDC guidelines provide evidence-based recommendations for infection prevention following surgery, including in patients undergoing joint replacement.",
author = "Peel, {Trisha Nicole}",
year = "2018",
doi = "10.1007/978-3-319-65250-4_6",
language = "English",
isbn = "9783319652498",
pages = "247--256",
editor = "Trisha Peel",
booktitle = "Prosthetic Joint Infections",
publisher = "Springer",

}

Peel, TN 2018, Prosthetic Joint Infection: Guidelines and Recommendations Update. in T Peel (ed.), Prosthetic Joint Infections. Springer, Cham, Switzerland, pp. 247-256. https://doi.org/10.1007/978-3-319-65250-4_6

Prosthetic Joint Infection : Guidelines and Recommendations Update. / Peel, Trisha Nicole.

Prosthetic Joint Infections. ed. / Trisha Peel. Cham, Switzerland : Springer, 2018. p. 247-256.

Research output: Chapter in Book/Report/Conference proceedingChapter (Book)Otherpeer-review

TY - CHAP

T1 - Prosthetic Joint Infection

T2 - Guidelines and Recommendations Update

AU - Peel, Trisha Nicole

PY - 2018

Y1 - 2018

N2 - Joint replacement surgery is a modern success story with clear clinical and societal benefits; infection of the prosthesis is one of the most feared complications. The behaviour of microorganisms in the setting of prosthetic material and the role of biofilm dictate the approaches to diagnosis and management of these infections. Recognising the impact of patient-related factors, such as diabetes mellitus and obesity, on the development of infections is important.Diagnosing infection requires application and interpretation of a number of investigations: no investigation has perfect sensitivity or specificity. A high index of suspicion for infection is key, especially in patients with painful joints. Suspicion of infection calls for routine serum inflammatory markers, aspiration of the index joint for assessment of the synovial fluid white cell count and neutrophil percentage, and synovial fluid culture. With revision surgery or arthrotomy for suspected or proven infection, collection of three tissue samples minimum for microbiological culture and histological assessment aids diagnosis. Sonicating the prosthesis and/or applying molecular polymerase chain techniques helps in culture-negative cases, including in patients recently exposed to antimicrobials. Newer tests such as alpha-defensin are promising but need further examination.Management is contingent on acuity of presentation and organisms isolated. Debridement and implant retention strategies with administration of anti-biofilm agents are a reasonable strategy with acute infection with stable implant. Chronic infections require removal with or without reimplantation of a new prosthesis. Optimal duration of antimicrobial therapy remains under investigation.Prevention targets optimisation of comorbid disease in patients undergoing joint replacement and minimising wound contamination during and after surgery. Recent WHO and CDC guidelines provide evidence-based recommendations for infection prevention following surgery, including in patients undergoing joint replacement.

AB - Joint replacement surgery is a modern success story with clear clinical and societal benefits; infection of the prosthesis is one of the most feared complications. The behaviour of microorganisms in the setting of prosthetic material and the role of biofilm dictate the approaches to diagnosis and management of these infections. Recognising the impact of patient-related factors, such as diabetes mellitus and obesity, on the development of infections is important.Diagnosing infection requires application and interpretation of a number of investigations: no investigation has perfect sensitivity or specificity. A high index of suspicion for infection is key, especially in patients with painful joints. Suspicion of infection calls for routine serum inflammatory markers, aspiration of the index joint for assessment of the synovial fluid white cell count and neutrophil percentage, and synovial fluid culture. With revision surgery or arthrotomy for suspected or proven infection, collection of three tissue samples minimum for microbiological culture and histological assessment aids diagnosis. Sonicating the prosthesis and/or applying molecular polymerase chain techniques helps in culture-negative cases, including in patients recently exposed to antimicrobials. Newer tests such as alpha-defensin are promising but need further examination.Management is contingent on acuity of presentation and organisms isolated. Debridement and implant retention strategies with administration of anti-biofilm agents are a reasonable strategy with acute infection with stable implant. Chronic infections require removal with or without reimplantation of a new prosthesis. Optimal duration of antimicrobial therapy remains under investigation.Prevention targets optimisation of comorbid disease in patients undergoing joint replacement and minimising wound contamination during and after surgery. Recent WHO and CDC guidelines provide evidence-based recommendations for infection prevention following surgery, including in patients undergoing joint replacement.

U2 - 10.1007/978-3-319-65250-4_6

DO - 10.1007/978-3-319-65250-4_6

M3 - Chapter (Book)

SN - 9783319652498

SP - 247

EP - 256

BT - Prosthetic Joint Infections

A2 - Peel, Trisha

PB - Springer

CY - Cham, Switzerland

ER -

Peel TN. Prosthetic Joint Infection: Guidelines and Recommendations Update. In Peel T, editor, Prosthetic Joint Infections. Cham, Switzerland: Springer. 2018. p. 247-256 https://doi.org/10.1007/978-3-319-65250-4_6