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Diagnosis and management of prosthetic joint infection

Peel, Trisha N.a,b; Buising, Kirsty L.b; Choong, Peter F.M.a,c

Current Opinion in Infectious Diseases: December 2012 - Volume 25 - Issue 6 - p 670–676
doi: 10.1097/QCO.0b013e32835915db
ANTIMICROBIAL AGENTS: Edited by Monica A. Slavin, Simon L. Croft and Deenan Pillay
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Purpose of review Prosthetic joint infection remains a devastating complication of arthroplasty associated with significant patient morbidity. The demand for arthroplasty is rapidly growing with a corresponding increase in the number of infections involving the prosthesis. The diagnosis and treatment of prosthetic joint infections presents a significant challenge to orthopaedic and infectious diseases clinicians.

Recent findings The underlying pathogenesis of prosthetic joint infections is due to the ability of the microorganisms to form a biofilm. The biofilm provides protection against host immune responses and antimicrobial therapy. In addition, it impedes standard laboratory diagnostic techniques. This review will examine new investigations to improve the diagnostic yield and rapidity of diagnosis of infections, including the use of sonication to disrupt the biofilm, new molecular tests to improve the detection of infecting microorganisms and new imaging techniques such as 18F-fluoro-deoxyglucose PET.

Summary The successful treatment of prosthetic joint infections is dependent on eliminating the biofilm dwelling microorganisms whilst maintaining patient mobility and quality of life. This review will examine current understanding of management approaches for these infections, with a particular focus on antimicrobial therapy with activity against the biofilm, such as rifampicin and fluoroquinolones.

aDepartment of Surgery, University of Melbourne, Melbourne

bDepartment of Infectious Diseases

cDepartment of Orthopaedic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia

Correspondence to Dr Trisha N. Peel, MBBS, FRACP, Department of Infectious Diseases, St Vincent's Hospital, Melbourne, VIC 3065, Australia. Tel: +61 3 9288 3639; fax: +61 3 9288 2571; e-mail: tpeel@student.unimelb.edu.au

© 2012 Lippincott Williams & Wilkins, Inc.