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Affiliation(s)
- Adam Coughlan
- A. Coughlan, F. Taylor, The Gold Coast University Hospital, Southport, Queensland, Australia
| | - Fraser Taylor
- A. Coughlan, F. Taylor, The Gold Coast University Hospital, Southport, Queensland, Australia
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2
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Tevell S, Christensson B, Nilsdotter-Augustinsson Å, Rydén C, Ryding U, Söderquist B, Åkerlund B. [Treatment of orthopedic implant-associated infections]. Lakartidningen 2019; 116:FR6C. [PMID: 31638706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The Swedish National Guidelines for Bone and Joint Infections were revised during 2018. The work was carried out on behalf of the Swedish Society for Infectious Diseases. The study group consists of senior consultants in infectious diseases, supported by specialists in orthopedic surgery, clinical microbiology and allergology when needed. The study group emphasizes that implant associated infections are challenging and requires multidisciplinary cooperation, including, but not limited to, specialists in orthopedic surgery, infectious diseases, clinical microbiology and radiology for optimal treatment results. All aspects of the clinical management are equally important; selecting the optimal antibiotic prophylaxis in arthroplasty as well as fracture surgery, early diagnosis of infection, adequate treatment, follow-up, and finally a structured evaluation of outcome. Profound and updated knowledge of treatment of biofilm related infection is necessary to achieve optimal results in patients with implant-associated infections. Future challenges include improved decision support for combining surgical treatment with selection of proper antibiotics, as well as management of antibiotic resistance, drug-drug interactions and adverse effects of antibiotic treatment.
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Affiliation(s)
- Staffan Tevell
- Infektionskliniken, Centralsjukhuset i Karlstad - Centrum för Klinisk Forskning, Region Värmland Karlstad, Sweden - Infektionskliniken Karlstad, Sweden
| | - Bertil Christensson
- avd. för Infektionsmedicin, Lunds Universitet - Lund, Sweden avd. för Infektionsmedicin, Lunds Universitet - Lund, Sweden
| | - Åsa Nilsdotter-Augustinsson
- Infektionskliniken Region Östergötland, Vrinnevisjukhuset Norrköping - Norrköping, Sweden Infektionskliniken Region Östergötland, Vrinnevisjukhuset Norrköping - Norrköping, Sweden
| | - Cecilia Rydén
- Infektionskliniken Helsingborgs lasarett - Helsingborg, Sweden Infektionskliniken Helsingborgs lasarett - Helsingborg, Sweden
| | - Ulf Ryding
- Infektionskliniken Östersunds sjukhus - Östersund, Sweden Infektionskliniken Östersunds sjukhus - Östersund, Sweden
| | - Bo Söderquist
- Örebro Universitet Institutionen för Medicinska Vetenskaper - Infektionskliniken, Universitetssjukhuset i Örebro Orebro, Sweden Laboratoriemedicinska länskliniken - Klinisk Mikrobiologi Örebro, Sweden
| | - Börje Åkerlund
- Karolinska Institutet Institutionen för medicin Huddinge - Enheten för Infektionssjukdomar, Karolinska Universitetssjukhuset Huddinge/Stockholm Huddinge, Sweden Karolinska Institutet Institutionen för medicin Huddinge - Enheten för Infektionssjukdomar, Karolinska Universitetssjukhuset Huddinge/Stockholm Huddinge, Sweden
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3
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Polewczyk A, Janion M, Kutarski A. Cardiac device infections: definition, classification, differential diagnosis, and management. ACTA ACUST UNITED AC 2016; 126:275-83. [PMID: 27074692 DOI: 10.20452/pamw.3366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cardiac device infections (CDIs) continue to be a serious clinical problem, with varying terminology and different classifications constituting one of the major diagnostic and therapeutic challenges in routine clinical practice. The problem invariably arises during an attempt to estimate the extent of the infection, which in consequence determines the choice of treatment strategy (duration of antibiotic therapy). The most serious form of CDI is lead-related infective endocarditis (LRIE). There are no clearly established diagnostic criteria for this disease; the available Duke University criteria are difficult to apply in patients with a suspicion of LRIE because of low sensitivity. As the treatment of LRIE is expensive and troublesome, there is a tendency to underdiagnose this condition and seek any intermediary forms between local pocket infection and definite LRIE. The present review includes suggestions for the systematization of CDIs with a clear definition of LRIE as a separate and most severe entity among CDIs.
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4
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Eyer M, Sendi P. [Periprosthetic joint infections: a practical overview for family physicians]. Rev Med Suisse 2014; 10:1871-1875. [PMID: 25417357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Periprosthetic joint infection is a rare but serious complication. Its management requires the collaboration between general practitioner, orthopaedic surgeon and infectious disease specialist. A delay in the diagnosis can result in complications, requiring complex surgical procedures. Identification of the causative pathogen and its susceptibility pattern is crucial, because it guides both the choice of antimicrobial treatment and the surgical strategy. Antimicrobial treatment without proper micro- biological sampling must be avoided. Swabs from open wounds are not helpful, because microorganisms belonging to the skin flora will grow. The target audience of this review article on periprosthetic joint infections is the general practitioner.
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5
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Parvizi J. New definition for periprosthetic joint infection. Am J Orthop (Belle Mead NJ) 2011; 40:614-615. [PMID: 22268006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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6
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Société de Pathologie Infectieuse de Langue Française (SPILF); Collège des Universitaires de Maladies Infectieuses et Tropicales (CMIT); Groupe de Pathologie Infectieuse Pédiatrique (GPIP); Société Française d’Anesthésie et de Réanimation (SFAR); Société Française de Chirurgie Orthopédique et Traumatologique (SOFCOT); Société Française d’Hygiène Hospitalière (SFHH); Société Française de Médecine Nucléaire (SFMN); Société Française de Médecine Physique et de Réadaptation (SOFMER); Société Française de Microbiologie (SFM); Société Française de Radiologie (SFR-Rad); Société Française de Rhumatologie (SFR-Rhu). Recommendations for bone and joint prosthetic device infections in clinical practice (prosthesis, implants, osteosynthesis). Société de Pathologie Infectieuse de Langue Française. Med Mal Infect. 2010;40:185-211. [PMID: 20303685 DOI: 10.1016/j.medmal.2009.12.009] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2009] [Indexed: 12/15/2022]
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7
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Abstract
Infections still remain one of the most devastating complications in hip joint surgery. Classification of these infections help the orthopaedic surgeon to identify the acuteness or chronicity of the infection, predict the complexity of the treatment procedure and ensure that all necessary device are available at the time of the revision surgery. The present article reviews the actual literature and provides an overview of clinical, arthroscopic, microbiological and radiological staging systems.
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Affiliation(s)
- Konstantinos Anagnostakos
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätskliniken des Saarlandes, Homburg/Saar, Germany.
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8
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Little JW, Falace DA, Miller CS, Rhodus NL. Antibiotic prophylaxis in dentistry: an update. Gen Dent 2008; 56:20-28. [PMID: 18254556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Antibiotics are used in dentistry to treat an existing infection therapeutically or to prevent an infection prophylactically. To prevent a perioperative infection (primary prophylaxis), prophylactic antibiotics may be administered when a surgical device, such as a prosthetic cardiac valve, is placed. They also may be administered to patients who have an existing medical condition or have received a previously placed device to reduce the risk of infection from a bacteremia (secondary prophylaxis). Although it is common to prescribe secondary prophylaxis for many dental conditions, there is a general lack of scientific evidence of its effectiveness and accumulating evidence suggests that such prescriptions may be unnecessary. In the past, antibiotic prophylaxis has been used for conditions with no proven benefit. Risks associated with antibiotics include allergic reactions (for example, anaphylaxis), development of antibiotic-resistant bacteria, development of superinfections, pseudomembranous colitis, cross-reactions with other drugs, and death. The costs involved with the use of antibiotics can be significant as well. This article reviews the current status of secondary antibiotic prophylaxis use in dentistry.
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Ghanem E, Jaberi FM, Parvizi J. Periprosthetic infection in a nutshell. Am J Orthop (Belle Mead NJ) 2007; 36:520-525. [PMID: 18033562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Elie Ghanem
- Rothman Institute of Orthopedics, Thomas Jefferson University, Philadelphia, PA, USA
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10
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Riedel F, Hönle W, Göske J, Kachler W, Holzwarth U, Schuh A. [Examination of granuloma of revised cemented or cementless total hip arthroplasties using inductively coupled plasma atomic emission spectrometry (ICP-OES)]. BIOMED ENG-BIOMED TE 2006; 51:15-20. [PMID: 16771125 DOI: 10.1515/bmt.2006.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Aseptic loosening is the most common problem in total hip arthroplasty (THA). One main aspect is inflammatory reaction against wear particles of the prosthesis materials. Analysing failure mechanisms in THA analysis of the particles and their element distribution of revised granulomatous tissue is essential to improve materials used in THA. MATERIALS AND METHODS 23 granulomas of revised THA due to aseptic loosening, 13 of which with metal on metal bearing (M/M), were analysed using inductively coupled plasma atomic emission spectrometry (ICP-OES). RESULTS Elements Cr, Mn, Ni, Al, Cu, Zn, Cd, Ti, V, Zr, Nb and Fe could be detected. The maximum value of Cr was 23.88 ppb (parts per billion), Al 191.02 ppb, Ni 64.95 ppb and Zr 9.96 ppb. The highest value of Al could be found in cementless implants. The maximum value of the elements Cr and Ni could be detected in M/M. In cemented implants the highest value of Zr was found. DISCUSSION The origin of Zr was the used bone cement in cemented THA. The elements Cr and Ni were significantly higher in M/M bearings. The highest value of Al was detected in granulomas of revised corund rough blasted cementless implants. The histopathologic findings of the revised M/M bearings have been published recently. Inductively Coupled Plasma Atomic Emission Spectrometry (ICP-OES) could not show any differences of the alloying constituents in cases with or without allergic reactions. ICP-OES analysis seems to be not useful examination of histologic sections using SEM with cryotransfer unit.
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Affiliation(s)
- Frank Riedel
- Orthopädische Klinik Rummelsberg, Schwarzenbruck, Deutschland.
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11
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Trampuz A, Zimmerli W. New strategies for the treatment of infections associated with prosthetic joints. Curr Opin Investig Drugs 2005; 6:185-90. [PMID: 15751742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Treatment of infections associated with orthopedic devices usually requires appropriate surgical intervention combined with a prolonged course of antimicrobial therapy. The choice of optimal management depends on duration and pathogenesis of infection, stability of the implant, antimicrobial susceptibility of the pathogen and condition of the soft tissue. The role of rifampin in combination with quinolones, minocycline, co-trimoxazole or fusidic acid in the treatment of staphylococcal infections is outlined in this review. Increasing antimicrobial resistance requires the use of alternative agents, such as quinupristin-dalfopristin, linezolid and daptomycin, but results of clinical trials are limited. Finally, agents with a potential for treatment or prophylaxis of device-associated infections, such as novel rifamycin derivatives, and compounds acting on bacterial quorum-sensing mechanisms are presented in this review.
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Affiliation(s)
- Andrej Trampuz
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, CH 4031 Basel, Switzerland
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12
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Abstract
The groin is the commonest site for graft infections in vascular surgery. This is a potentially catastrophic situation as limb loss or even death occurs in a large percentage of cases. Standard teaching for treatment of infected vascular grafts is removal and extra anatomical bypass grafting whilst commencing appropriate antibiotics. This review article suggests careful scrutiny of the wound, debridement and coverage of the graft with a vascularised muscular flap is appropriate in certain situations.
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Affiliation(s)
- I M Williams
- Department of Surgery, Royal Gwent Hospital, Cardiff Road, Newport, Gwent NP20 2UB, Wales, UK
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Abstract
The aim of this study was to evaluate, retrospectively, the diagnostic value of Tc hexamethylpropylene amine oxime (99mTc-HMPAO) labelled autologous leucocytes for the preferred septic localizations of the infection of the endoprosthesis. We retrospectively reviewed 67 patients with implanted endoprostheses. Diagnosis was found in 42/67 patients. In 25/67 patients we were able to negate an acute pathological process of infection of the endoprosthesis. Our patients were divided into three groups according to the type of endoprosthesis (hip joint, knee joint, shoulder joint). The localizations of the endoprosthesis disorders are shown. The preferred localizations of the acute infection of the hip endoprosthesis are the regio intertrochanterica and the middle part of the shaft of the prosthesis. The preferred localization of the acute infection of the knee endoprosthesis is the proximal shaft of the tibia. The preferred localization of the acute infection of the shoulder endoprosthesis is the distal end of the prosthesis in the proximal humerus. It is hoped that the knowledge of these preferred localizations of infection of endoprosthesis will help patients and doctors in diagnosis and treatment in the future.
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Affiliation(s)
- G Wolf
- Department of Radiology, Division of Nuclear Medicine, Karl-Franzens University Graz, Austria.
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Lambert J, Devos S, Olamazadeh S. [Surgical treatment aspects in osteo-articular infections in the adult]. Rev Med Brux 2001; 22:A51-3. [PMID: 11252907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- J Lambert
- Service de Chirurgie Orthopédique, C.H.U. Ambroise Paré, Mons, U.L.B
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15
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Abstract
We have studied prospectively the outcome of wound discharge in patients after arthroplasty of the hip and knee. Over a period of 3.5 years 530 primary arthroplasties were carried out in one hospital. Postoperative wound infections developed in 82. At a mean follow-up of two years a comparison was made between these patients and 82 with healthy wounds, in terms of symptoms and signs of deep infection. There was an incidence of 1.1% of early deep infection, within six weeks in all cases. The rate of 'superficial' infection was 17.3% in the hips, 10.5% in the knees and 14.3% in total. At a mean follow-up of 26 months, there were no significant differences between the patients with infected wounds and a matched group of patients with healthy wounds in terms of the ESR, level of C-reactive protein, white cell count and radiological scores, but clinical scores were significantly worse in the patients with infected knees (p < 0.05). The length of stay was also significantly longer in this group (mean 14.6 days in the healthy wound group, 19 days in the problem group; p < 0.005). There was, however, no convincing evidence that these wound infections led to deep infection and early revision in the early to medium follow-up period. A larger and longer prospective trial would be necessary to shed more light on this potential problem.
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Affiliation(s)
- W J Gaine
- Department of Orthopaedics, Southern General Hospital, Glasgow, Scotland, UK
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McPherson EJ, Tontz W, Patzakis M, Woodsome C, Holtom P, Norris L, Shufelt C. Outcome of infected total knee utilizing a staging system for prosthetic joint infection. Am J Orthop (Belle Mead NJ) 1999; 28:161-5. [PMID: 10195839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
This study reviews, over a 5-year period, the records of 70 consecutive patients with prosthetic knee infection and evaluates outcomes as a function of a staging system for prosthetic joint infection. The staging system for prosthetic joint infection was divided into three main categories that include infection type, systemic host grade, and local extremity grade. Outcome indices analyzed included Knee Society Score (KSS), complication rate, amputation rate, and rate of permanent resection. We show that categorizing and stratifying data for patients with infected total knee arthroplasty are useful. A universally accepted staging system would allow for more objective comparisons of treatments and may eventually define particular treatment regimens for particular classes of patients.
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Affiliation(s)
- E J McPherson
- Department of Orthopaedic Surgery, University of Southern California School of Medicine, Los Angeles, USA
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Masterson EL, Masri BA, Duncan CP. Treatment of infection at the site of total hip replacement. Instr Course Lect 1998; 47:297-306. [PMID: 9571431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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McPherson EJ, Patzakis MJ, Gross JE, Holtom PD, Song M, Dorr LD. Infected total knee arthroplasty. Two-stage reimplantation with a gastrocnemius rotational flap. Clin Orthop Relat Res 1997:73-81. [PMID: 9269158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study reviews a consecutive series of 21 patients undergoing two-stage reimplantation total knee arthroplasty for late chronic infection. All 21 patients had late chronic infections, and 20 of 21 patients were compromised hosts. Seven different organisms were isolated at the time of prosthetic resection. Staphylococcus coagulase negative species was the most frequently isolated organism. At the time of reimplantation, a medial gastrocnemius rotational flap was rotated over the proximal tibia and knee for wound closure. The average explantation time was 25 weeks (range, 7-76 weeks), and no methylmethacrylate spacers were used. At an average 17-month followup (range, 5.1-33.1 months) all reimplanted total knee replacements remained in place with one patient having recurrent infection. At reimplantation, 11 patients had positive bacterial cultures from tissue specimens. Sixteen of the 33 (40%) positive cultures were from specimens taken from the medullary canal. At followup, the average Knee Society Score was 77.4 (range, 40-100). The lack of a methylmethacrylate spacer and a long explantation time were considered important factors in diminishing functional performance and determining the need for a gastrocnemius flap. A medial gastrocnemius rotational flap should be considered at the time of reimplantation total knee arthroplasty if the soft tissue envelope about the knee is compromised and cannot be closed without undue tension.
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Affiliation(s)
- E J McPherson
- University of Southern California School of Medicine, Los Angeles, USA
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Affiliation(s)
- K L Garvin
- Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha 68198-1080, USA
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Bandyk DF, Esses GE. Prosthetic graft infection. Surg Clin North Am 1994; 74:571-90. [PMID: 8197531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This article outlines the tenets and basic data critical for the management of prosthetic graft infections. Diagnostic algorithms and treatment options appropriate for patients with symptoms and signs suggestive of graft infection are presented.
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Affiliation(s)
- D F Bandyk
- Department of Surgery, University of South Florida College of Medicine, Tampa
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Levine SE, Esterhai JL, Heppenstall RB, Calhoun J, Mader JT. Diagnoses and staging. Osteomyelitis and prosthetic joint infections. Clin Orthop Relat Res 1993:77-86. [PMID: 8403673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The diagnoses of osteomyelitis and prosthetic joint infections are usually made on the basis of clinical, laboratory, and radiographic examination. The diagnostic studies presently employed to diagnosis and assess osteomyelitis and prosthetic joint infections are described. A universally applied classification system for stratifying osteomyelitis and prosthetic joint infection would provide a framework for the evaluation of medical and surgical treatment efficacy. Such a system would enable treatment results to be compared among institutions. Staging systems currently being used are described.
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Affiliation(s)
- S E Levine
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia
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Bandyk DF. Diagnosis and treatment of biomaterial-associated vascular infections. Infect Dis Clin North Am 1992; 6:719-29. [PMID: 1431048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Management of biomaterial-associated vascular infections requires an understanding of pathogenetic mechanisms, risk factors, and microbiologic characteristics. Staphylococci sp., especially slime-producing strains of S. epidermidis are the prevalent pathogens. Experimental and clinical studies have indicated in situ replacement, particularly with an antibiotic-bonded prosthesis, as effective treatment for infections caused by coagulase-negative staphylococci. When sepsis is a presenting sign, prompt intervention, total excision of the prosthesis, and antibiotic administration are required.
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Affiliation(s)
- D F Bandyk
- Department of Surgery, University of South Florida College of Medicine, Tampa
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