Published 28 July 2009, doi:10.1136/bmj.b3052
Cite this as: BMJ 2009;339:b3052

Letters

Prosthetic joint infection

Treatment without long courses of systemic antibiotics

The first 150 words of the full text of this article appear below.

We manage prosthetic joint infection without systemic antibiotics or prolonged hospital admission (or intravenous antibiotics via outpatient intravenous services).¹ We target antibiotic treatment to organisms isolated from either a diagnostic aspirate or joint washout (in the case of early infection). At the first stage revision, after thorough debridement of all infected material, we then use cement beads loaded with an appropriate antibiotic based on the aspirate results.^{2 3}

Systemic antibiotics are generally not required beyond surgical prophylaxis because high eluted concentrations of antibiotic from the cement beads provide effective local antimicrobial activity with minimal or no systemic absorption. Outcome data using this approach are comparable to those described by Matthews and colleagues.⁴

Matthews and colleagues state that managing prosthetic joint infection with antibiotic loaded spacers is expensive and time consuming and results in tissue damage. We think that infected prosthetic material requires surgical debridement along with dead tissue and bone, which . . . [Full text of this article]

¹ Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU

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Diagnosis and management of prosthetic joint infection

Philippa C Matthews, Anthony R Berendt, Martin A McNally, and Ivor Byren
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