Conservative treatment of staphylococcal prosthetic joint infections in elderly patients

BACKGROUND: We report the outcome of debridement and prosthesis retention plus long- term levo-floxacin/ rifampicin treatment of prosthetic joint infections. METHODS: Staphylococcal prosthesis joint infections were defined by positive culture of joint aspirate, intraoperative debridement specimens, or sinus tract discharge in the presence of clinical criteria. Patients received long- term oral levofloxacin 500 mg and rifampicin 600 mg once per day. Sixty patients ( age 74.6 +/- 8.4 years) were included. RESULTS: Coagulase- negative staphylococci were significantly more frequently isolated in the knee ( 78.6%; P =. 00001). Of the Staphylococcus aureus isolates, 33.3% were methicillin-resistant. Time from arthroplasty to symptoms onset was higher ( P =. 03) in coagulase- negative staphylococci infections. Global failure was 35% ( higher for the knee) and ranged from 16.6% to 69.2% ( P =. 0045) in patients with symptoms duration of less than 1 month to more than 6 months. A shorter duration of symptoms ( P =. 001) and time to diagnosis ( P =. 01) were found in cured patients versus patients showing failure. Among those with S. aureus infections, a higher failure rate was found with methicillin- resistance. CONCLUSIONS: Efficacy was higher in patients with shorter duration of symptoms, earlier diagnosis, hip infections, and methicillin susceptibility. (c) 2006 Elsevier Inc. All rights reserved.