Optimization of the empirical antibiotic choice during the treatment of acute prosthetic joint infections: a retrospective analysis of 91 patients.

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  • Additional Information
    • Affiliation:
      Department of Orthopaedic Surgery, Catharina Hospital Eindhoven, Eindhoven
      Orthopaedic Center Máxima, Máxima Medical Center, Eindhoven
      Laboratory of Medical Microbiology, Stichting PAMM, Veldhoven, The Netherlands
    • Subject Terms:
    • Subject Terms:
    • Abstract:
      Background and purpose — The preferred treatment of an acute prosthetic joint infection (PJI) is debridement, antibiotics, irrigation and retention of the prosthesis (DAIR). The antibiotic treatment consists of an empirical and targeted phase. In the empirical phase, intravenous antibiotics are started after surgery before micro-organisms are determined in microbiological cultures. Which empirical antibiotic is used differs between hospitals, partly reflecting geographic differences in susceptibility spectrums. We investigated whether flucloxacillin should remain the antibiotic of choice in our hospital for empiric treatment of acute PJI with DAIR. Patients and methods — We retrospectively analyzed 91 patients treated for PJI with DAIR between 2012 and 2016. The susceptibility of micro-organisms was determined in multiple cultures of periprosthetic tissue and synovial fluid for 3 antibiotics: amoxicillin/clavulanic acid, cefazolin, and flucloxacillin. Results — Positive microbiological cultures from 68 patients were analyzed. Staphylococcus aureus was the predominant pathogen, cultured in half of the patients. In one-third of patients more than 1 micro-organism was found. On a patient level, the data showed that 65% were responsive to flucloxacillin, 76% to amoxicillin/clavulanic acid, and 79% to cefazolin. Interpretation — Flucloxacillin appeared to be a suboptimal choice in our patient population treated with DAIR. We therefore changed our practice to cefazolin as the preferred antibiotic in the empirical treatment of acute PJI with DAIR.
    • Journal Subset:
      Allied Health; Biomedical; Continental Europe; Europe; Peer Reviewed
    • ISSN:
      1745-3674
    • MEDLINE Info:
      NLM UID: 101231512
    • Publication Date:
      20190914
    • Publication Date:
      20190921
    • Accession Number:
      http://dx.doi.org/10.1080/17453674.2019.1621595
    • Accession Number:
      138549126
  • Citations
    • ABNT:
      VAN ERP, J. H. J. et al. Optimization of the empirical antibiotic choice during the treatment of acute prosthetic joint infections: a retrospective analysis of 91 patients. Acta Orthopaedica, [s. l.], v. 90, n. 5, p. 455–459, 2019. DOI 10.1080/17453674.2019.1621595. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=ccm&AN=138549126&custid=s6224580. Acesso em: 7 dez. 2019.
    • AMA:
      Van Erp JHJ, Heineken AC, Van Wensen RJA, et al. Optimization of the empirical antibiotic choice during the treatment of acute prosthetic joint infections: a retrospective analysis of 91 patients. Acta Orthopaedica. 2019;90(5):455-459. doi:10.1080/17453674.2019.1621595.
    • APA:
      Van Erp, J. H. J., Heineken, A. C., Van Wensen, R. J. A., Van Kempen, R. W. T. M., Hendriks, J. G. E., Wegdam-Blans, M., … Van Der Steen, M. C. (Marieke). (2019). Optimization of the empirical antibiotic choice during the treatment of acute prosthetic joint infections: a retrospective analysis of 91 patients. Acta Orthopaedica, 90(5), 455–459. https://doi.org/10.1080/17453674.2019.1621595
    • Chicago/Turabian: Author-Date:
      Van Erp, Joost H J, Adriaan C Heineken, Remco J A Van Wensen, Robin W T M Van Kempen, Johannes G E Hendriks, Marjolijn Wegdam-Blans, Judith M Fonville, and M C (Marieke) Van Der Steen. 2019. “Optimization of the Empirical Antibiotic Choice during the Treatment of Acute Prosthetic Joint Infections: A Retrospective Analysis of 91 Patients.” Acta Orthopaedica 90 (5): 455–59. doi:10.1080/17453674.2019.1621595.
    • Harvard:
      Van Erp, J. H. J. et al. (2019) ‘Optimization of the empirical antibiotic choice during the treatment of acute prosthetic joint infections: a retrospective analysis of 91 patients’, Acta Orthopaedica, 90(5), pp. 455–459. doi: 10.1080/17453674.2019.1621595.
    • Harvard: Australian:
      Van Erp, JHJ, Heineken, AC, Van Wensen, RJA, Van Kempen, RWTM, Hendriks, JGE, Wegdam-Blans, M, Fonville, JM & Van Der Steen, MC (Marieke) 2019, ‘Optimization of the empirical antibiotic choice during the treatment of acute prosthetic joint infections: a retrospective analysis of 91 patients’, Acta Orthopaedica, vol. 90, no. 5, pp. 455–459, viewed 7 December 2019, .
    • MLA:
      Van Erp, Joost H. J., et al. “Optimization of the Empirical Antibiotic Choice during the Treatment of Acute Prosthetic Joint Infections: A Retrospective Analysis of 91 Patients.” Acta Orthopaedica, vol. 90, no. 5, Oct. 2019, pp. 455–459. EBSCOhost, doi:10.1080/17453674.2019.1621595.
    • Chicago/Turabian: Humanities:
      Van Erp, Joost H J, Adriaan C Heineken, Remco J A Van Wensen, Robin W T M Van Kempen, Johannes G E Hendriks, Marjolijn Wegdam-Blans, Judith M Fonville, and M C (Marieke) Van Der Steen. “Optimization of the Empirical Antibiotic Choice during the Treatment of Acute Prosthetic Joint Infections: A Retrospective Analysis of 91 Patients.” Acta Orthopaedica 90, no. 5 (October 2019): 455–59. doi:10.1080/17453674.2019.1621595.
    • Vancouver/ICMJE:
      Van Erp JHJ, Heineken AC, Van Wensen RJA, Van Kempen RWTM, Hendriks JGE, Wegdam-Blans M, et al. Optimization of the empirical antibiotic choice during the treatment of acute prosthetic joint infections: a retrospective analysis of 91 patients. Acta Orthopaedica [Internet]. 2019 Oct [cited 2019 Dec 7];90(5):455–9. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=ccm&AN=138549126&custid=s6224580