IDSA guidelines aim to reduce death, disability and cost of prosthetic joint infections

Multispecialty physician teams need to work together to reduce disability, death and costs associated with the ever-growing number of prosthetic joint infections, said the first guidelines on the topic released by the Infectious Diseases Society of America (IDSA).

The guidelines appeared online at the IDSA website and in the Dec. 7 Clinical Infectious Diseases.

Joint infections require multidisciplinary teams, including an orthopedist and an infectious disease specialist, as well as other specialists on a case-by-case basis, the guidelines advise. For instance, if the patient is older and has heart disease, an internist should be involved, and if the surgical wound is difficult to close, a plastic surgeon should be consulted.

In rural areas with few specialists, doctors should consider consulting with infectious disease specialists or orthopedists at referral centers.

Physicians should suspect a prosthetic joint infection in a patient who has any of the following:

• persistent wound drainage in the skin over the joint replacement,
• sudden onset of a painful prosthesis, or
• ongoing pain after the prosthesis has been implanted, especially if there had been no pain for several years or if there is a history of prior wound healing problems or infections.

The following guidelines apply in patients with prosthetic joint infections:

• Those with a well-fixed prosthesis without an open wound to the skin who had surgery less than 30 days previously are likely candidates for debridement, which means reopening the incision and cleaning out the wound.
• Those who have more extensive infection that has affected the bone and tissue may need to have the prosthesis replaced, either in the same surgery in which the prosthesis is removed or in a later surgery.
• Patients who cannot walk and who have limited bone stock, poor soft tissue coverage and infections due to highly resistant organisms may need to have the implants permanently removed. In some cases the joint may need to be fused.
• Amputation of the limb may be necessary, but only as a last resort. Prior to amputation, the patient should be referred to a center with specialist experience in prosthetic joint infections if his or her condition allows.

Four to six weeks of intravenous or highly bioavailable oral antibiotic therapy is almost always necessary to treat prosthetic joint infections, according to the guidelines.