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Prosthetic joint infections (investigations (Joint aspiration confirms…
Prosthetic joint infections
At least 3 positive samples= the perform debridement surgery
Most common: Staph Aureus, Staph Epidermidis and Enterococcus. 75% of organisms are gram positive
investigations
Joint aspiration confirms diagnosis as it identifies organisms. And which antibiotics would be most suitable. It has to be done with patient's off antibiotics for at least 2 weeks
5 tissue samples --> microbiology culture
FBC, ESR and CRP (>10) and ESR (>30)
History and examination
X-rays
Vancymyocin, Gentacmicin, Clindamycin Cement in the joint. The 6 weeks of amoxicillan
PATHO
Cefuroxime and Teicomeia. Got a pasteurella canous. Wound related
Haemophilus parainfluenzae- from touching nose and then wound or animals licking wounds.
Diarrhoeal illness 5 months previously. Listera transient infection from cheese
Debridement and implant retention
DAIR procedure (debridement, antibiotics and implant retention)
Use for early postoperative infections or acute haematogenous infections. Not for chronic infections and if the prosthesis is not loose
need to go broad spectrum antibiotics. Antibiotic suppression happens when the patient is unfit for surgery has poor distal skin, low virulence infecting organism or the patient just tolerates antibiotics well
Staph- metal on metal environment. Ditched resistance genes to survive
PROPIONIBACTERIA (P.ACNES)very common in upper limb and spinal infections. Popular after surgery and are slow growers. Also common in CNS bacteria
There is an increasing incidence of the number of prosthetic joint infections. The inreasing incidence is not altered by a change in risk factors such as male sex, hip fracture and using cement without antibiotics
Aims of treatment
Relieve pain
Restore function to the joint
Eradicate sepsis
Amputation
One stage or Two stage exchange arthroplasty . Need to know what organism you're dealing with and need to use an appropiate antibiotic cover whilst also forming a sufficent joint and tissue cover
Excision arthroplasty is a process that is done on people that have not tolerated antibiotics well, frail, have co morbities. However, generally only done on old people as the result is poor functional outcome