Treatment of acute infection of total or partial hip arthroplasty with debridement and oral chemotherapy

BACKGROUND AND OBJECTIVE: The suitable antibiotic(s) and duration of treatment for hip prosthesis acute infections (HPAIs) has not been clearly defined. PATIENTS AND METHOD: We studied 32 patients whose HPAI was diagnosed within 2 months after surgery. All patients underwent debridement and samples were taken for culture purposes. Antibiotics were started and adjusted to the antibiogram. Ambulatory follow-up controls were carried out for more than 18 months after treatment had finished. RESULTS: There were 16 cases of staphylococcal infection while it was streptococcal in 2 cases, enterococcal in 6 and due to gram-negative bacillus in 6 patients. In 2 patients, the causal microorganism could not be identified. Patients with an infection due to gram-positive cocci (other than enterococci) were administered an association of antibiotics including rifampicin for a mean 2.7 months period. Outcome was favorable in 100% valuable cases, after a mean followup of 20.7 months. Patients with enterococcal infections were treated with a glycopeptide or beta-lactams for a mean of 2.6 months; all them had a unfavorable outcome. Out of 6 infections due to gram-negative bacilli, 2 valuable cases had a favorable evolution. CONCLUSIONS: HPAIs due to Staphylococcus sp. or Streptococcus sp. can be successfully treated by means of surgical debridement plus an antibiotic scheme that includes rifampicin for a maximum period of 3 monks. It is necessary to analyze the effectiveness of new antibiotics or antibiotic associations in cases of enterococcal infections.