Debridement and Management of Prosthetic Joint Infection ...
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Debridement and Management of Prosthetic Joint Infection (PJI)
Duration of symptoms <3 weeks OR  <30 days from arthroplasty AND
 • No hardware loosening
 • No sinus tracts
 • Known pathogen susceptible to PO agents
Debridement & implant retention (DAIR)
 • Duration:
    - Staphylococci: 24wk for knees, otherwise 12wk
        - Add rifampin if susceptible (or don’t if major DDIs/AEs)
    - Fungus: don’t do DAIR
    - Everything else: 12 weeks (based on 2021 DATIPO RTC)
 • Chronic suppression: shared decision-making
    - Should be exceptional/rare; no good data supporting practice
    - S.aureus or MDRs, prior tx failure, limited life expectancy, poor candidacy for future surgeries all contribute to decision about whether benefit > risk
    - Never “lifelong”: if suppressing, follow patient q6-12mo to assess med tolerance, discuss whether to continue therapy
Remove prosthesis:
 • 2-stage exchange:
    - Initial 6-12wk antibiotic therapy (12wk by DATIPO RTC)
    - >2 week antibiotic holiday prior to revision arthroplasty; any s/sx of relapsed infection should prompt arthrocentesis or change of surgical plan to antibiotic spacer exchange
    - Some groups trend ESR & CRP and/or do arthrocentesis on everyone before revision arthroplasty; data for this is poor
 • 1-stage exchange - Antibiotics as per DAIR, though benefit of 12wk vs 6wk not clear
 • Salvage methods: arthrodesis, amputation
    - Antibiotic approach individualized based on extent of residual infected tissue/bone/metal

ID Chalk Talks by Nico Cortes-Penfield @Cortes_Penfield

#PJI #Prosthetic #Joint #Infection #treatment #Debridement #Management 
Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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