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Chapter 10 : Ambulatory Management of Infected Orthopedic Implants

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Abstract:

This chapter talks about a new diagnostic and therapeutic approach based on the ambulatory management of infections to minimize the social consequences for the patient and the important economic impact for the community. Coagulase-negative staphylococci, streptococci, gram-negative aerobes, and anaerobes are the most common bacteria in late-onset prosthetic joint infections. Infections within the first few months of surgery usually present with pain, erythema, and drainage at the wound site. The combination of fleroxacin with rifampin resulted in a 41% cure rate in an foreign-body infection model. The addition of vancomycin to the fleroxacin-rifampin combination significantly increased the cure rate and the rapidity of sterilization of the foreign body. Fusidic acid can accumulate within cells, demonstrated by the fact that 7- to 10-fold intracellular compared with extracellular concentrations have been measured in human polymorphonuclear leukocytes and lymphocytes. The only antibiotics remaining active against multiresistant staphylococci and able to diffuse into the bone tissue are glycopeptides (vancomycin and teicoplanin) and co-trimoxazole. Bone marrow changes occur in patients with preexisting depleted folate stores and one recent report established that bone marrow changes occur in one case per 18,000 prescriptions. Ciprofloxacin has an excellent penetration into bone and an excellent MIC for . Ciprofloxacin alone is effective in the treatment of osteomyelitis. Salvage of infected orthopedic implants by appropriate antimicrobial strategies is feasible and the ambulatory management of such infections contributes to humanization of therapy.

Citation: Stein A, Drancourt M, Raoult D. 2000. Ambulatory Management of Infected Orthopedic Implants, p 211-230. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch10

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Figure 1

Plain radiograph of a total hip prosthesis. Note the loosening of the prosthesis at the bone-cement interfaces.

Citation: Stein A, Drancourt M, Raoult D. 2000. Ambulatory Management of Infected Orthopedic Implants, p 211-230. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch10
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Tables

Generic image for table
Table 1

Interpretation and strategy determined by microbiology of sample and antibiotic activity of sample and urine

Citation: Stein A, Drancourt M, Raoult D. 2000. Ambulatory Management of Infected Orthopedic Implants, p 211-230. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch10
Generic image for table
Table 2

Cure rates of the ofloxacin-rifampin combination for patients with infected orthopedic devices

Citation: Stein A, Drancourt M, Raoult D. 2000. Ambulatory Management of Infected Orthopedic Implants, p 211-230. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch10
Generic image for table
Table 3

Cure rates of the fusidic acid-rifampin combination for patients with infected orthopedic devices

Citation: Stein A, Drancourt M, Raoult D. 2000. Ambulatory Management of Infected Orthopedic Implants, p 211-230. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch10
Generic image for table
Table 4

Cure rates of co-trimoxazole for intention-to-treat patients with infected orthopedic devices

Citation: Stein A, Drancourt M, Raoult D. 2000. Ambulatory Management of Infected Orthopedic Implants, p 211-230. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch10

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