Joint implant infections in a general hospital
Abstract number: 1733_1425
Moreno F., Aguilar J., Noureddine M., De la Torre J., Prada J.L., Del Arco A., Merida L., Ruiz-Mesa J.D.
Objectives: to analyse features and sources of joint implant (JI) infections and the medical and surgical treatment in our hospital.
Method: Retrospective study of patients admitted suffrering from JI infections from 1997 to 2005. Hospital data base and discharge reports were used.
Results: 89 patients were admitted. 15 had 2 admissions and 8 three admisions with a total of 121 cases of JI infection. The mean-age was 73 ± 12.39 years. 64% were female. 22% were diabetic, 25% heart patients and 11% COAF patients. In 57% artrosis was the cause of JI indication, and 32% by fracture. 60% were hips (96% by fracture), and 38% from knee (63% by artrosis). 85% were the first JI: 81% complete/16% parcial. In 45% first symptom started in first month after surgery, 34% between 1 month and 2 years and 20% more than 2 years after surgery. Only 20% had risk factors for infection, 10% surgical wound infection and 10% haemorrhage and haematoma. The more recurrent symptoms were local inflamation or wound drainage in 50%, joint pain in 31% and fever in 14%, a fistula in 8% and in 2% joint effusion. Bacteria were isolated in 57%, in 36% from fistula or injure 9% from joint fluid and the others from surgical samples or blood stream. Only a bacteria was isolated in 82%. In 12% were 2 bacterias and in 6% more than 2. In 57% Staphylococcus was isolated (37% S. aureus, and 20% S. coagulase negative), in 19% Bacillus Gram-negatives (P. aeruginosa and E. coli), and 14% Streptococcus (beta-haemolytic streptococcus, viridans and enterococcus), and 6% were with more than 2. About therapy, surgical cleaned and antibiotical treatments were performed in 66%. JI was removed in 15% with reinstatement of a new JI. JI removed without a new implant and antibiotics in 9%. In the others, parcial JI were removed, cronic antibiotical treatment was indicated or amputation was made. The mean length of stay was 24 days (TD 19.33). Only 2 died. The common antibiotical combination was aminoglicosides plus cloxacilin or cefazoline, vancomycin or ciprofloxacin (44%), and cocktail with ciprofloxacin plus cloxacilin, rifampicin or vancomycin (16%). One case was treated only with one antibiotic. Ciprofloxacin was the wide used (12%). After discharged therapy was prolonged between 3 and 16 weeks with a mean of 7 weeks.
Conclusions: More than 50% were late JI infections but in less than 50% JI was removed. In the causes, S. aureus is the main bacteria followed by Staph coagulase negatives and Gram-negatives.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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