Orthopedic device-related infections

Prosthetic joint infection is an increasing public health problem. The bacterial biofilms that form on these foreign bodies are resistant to host defence mechanisms and antimicrobial therapy. Sixty per cent of prosthetic joint infections are caused by Staphylococcus sp., and they are usually acquired during surgery or in the early post-operative period, but can also occur by haernatogenous seeding. There are several kinds of prosthetic joint infections: early postoperative infection (EPI), late postoperative infection (LPI), haematogenous infection (HI), and positive operative cultures. In EPI and HI, early diagnosis is mandatory to save the implant, and in LPI the main issue is the differential diagnosis with aseptic loosening. The treatment of choice for susceptible staphylococcal EPI and HI is debridement and a combination of rifampin and levofloxacin for 8 weeks, with retention of the implant. In LPI, replacement of the prosthesis is required, followed by antibiotic therapy for 6 weeks.