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Description

Gram negative bacteria cause only a small percent of prosthetic joint infections but management of these infections can be difficult. Hsieh et al made a number of recommendations for managing a patient with a prosthetic joint infection (PJI) caused by a Gram negative bacteria. The authors are from Chang Gung Memorial Hospital in Taoyuan, Taiwan.


 

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.

 


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