The microbiology of the infected knee arthroplasty

• Published in: International orthopaedics Vol. 34; no. 4; pp. 505 - 510
• Main Authors: Nickinson, R. S. J., Board, T. N., Gambhir, A. K., Porter, M. L., Kay, P. R.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-04-2010
• Subjects: Adult; Age; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotics; Arthroplasty (knee); Arthroplasty, Replacement, Knee - adverse effects; Central nervous system; Coagulase; Coagulase - metabolism; Drug Therapy, Combination; Female; Gentamicin; Gentamicins - therapeutic use; Humans; Infection; Knee; Knee Joint - microbiology; Knee Joint - pathology; Male; Medicine; Medicine & Public Health; Microbial Sensitivity Tests; Middle Aged; Original Paper; Orthopedics; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - microbiology; Reoperation; Retrospective Studies; Staphylococcal Infections - diagnosis; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Staphylococcus - drug effects; Staphylococcus - enzymology; Staphylococcus - isolation & purification; Staphylococcus aureus; Surgical Wound Infection - diagnosis; Surgical Wound Infection - drug therapy; Surgical Wound Infection - microbiology; Teicoplanin; Treatment Outcome; Vancomycin; Vancomycin - therapeutic use; Vancomycin; Total Knee Arthroplasty; Bone Cement; Teicoplanin; Deep Infection
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-009-0797-y

We describe the results of a retrospective analysis of patients with microbiologically proven infection, who underwent revision TKA between 1994 and 2008. Of the 121 patients included in the study, 61 (50%) were male and 60 (50%) were female. The mean age was 71 (range 42–88) years. The most common organisms identified were Coagulase negative Staphylococcus (CNS) (49%) and
Staphylococcus aureus
(SA) (13%). The prevalence of CNS appears to be increasing, while that of SA and other organisms is decreasing. Vancomycin and teicoplanin were the most effective antibiotics with overall sensitivity rates of 100% and 96%, respectively. The results of our theoretical model suggest that gentamicin combined with vancomycin is the most effective empirical regimen. Staphylococcal species are the most common organisms encountered in deep infection of the knee. Gentamicin combined with vancomycin offers the most comprehensive protection and potentially allows for infected knee arthoplasties to be treated with a one-stage procedure.