Recommendations of Hsieh et al for the Management of a Prosthetic Joint Infection Due to a Gram Negative Bacteria

 

Patient selection: knee and hip orthopedic prostheses infected with a Gram negative bacteria (Pseudomonas aeruginosa or an Enterobacteria)

 

Reasons for difficulty in managing PJI caused by a Gram negative bacteria:

(1) The patients tend to be older and have more comorbid conditions.

(2) The Gram negative bacteria may be more virulent.

(3) The Gram negative bacteria may be resistant to multiple antibiotics.

 

In general the best strategy is to manage the infection aggressively.

 

The risk of treatment failure increases if there is a delay in treatment or if treatment is inappropriate.

 

A 2-stage exchange or resection arthroplasty is usually needed to control the infection. Debridement with retention of the prosthesis may be successful if performed as soon as possible after symptom onset. The rate of success drops off after 2 or 3 days with a low rate after 1 week.