Management of Prosthetic Joint Infection.

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Abstract

[Indexed for MEDLINE] 5. Expert Rev Anti Infect Ther. 2020 Apr;18(4):307-321. doi: 10.1080/14787210.2020.1729740. Epub 2020 Feb 19. Fracture-related infection: current methods for prevention and treatment. Foster AL(1)(2)(3)(4), Moriarty TF(1), Trampuz A(5), Jaiprakash A(2), Burch MA(1), Crawford R(2), Paterson DL(6), Metsemakers WJ(7)(8), Schuetz M(2)(3)(4), Richards RG(1). Author information: (1)AO Research Institute Davos, Davos, Switzerland. (2)Faculty of Science and Engineering, Queensland University of Technology (QUT), Brisbane, Australia. (3)Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Queensland, Australia. (4)Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Queensland, Australia. (5)Center for Musculoskeletal Surgery, Septic Unit Charité-Universitätsmedizin, Berlin, Germany. (6)University of Queensland Centre of Clinical Research (UQCCR), Brisbane, Australia. (7)Department of Trauma Surgery, University Hospitals Leuven, Belgium. (8)Department of Development and Regeneration, KU Leuven, Belgium. Introduction: Fracture-related infection (FRI) is a serious complication related to orthopedic trauma, both from an infectious disease and a surgical point of view. The lack of scientific data with respect to diagnostic criteria and treatment principles of this entity has hampered efforts for an evidence-based approach and, as such, practices to prevent and treat FRI are often extrapolated from peri-prosthetic joint infection (PJI) literature. Recently, consensus guidelines were developed with respect to prevention, diagnosis and treatment of FRI.Areas covered: This review will define FRI and approaches to prevent and treat this complication will be discussed, with an emphasis on antimicrobial and surgical considerations. Guidelines focusing on FRI will be highlighted and aspects of pre-clinical research with imminent translational potential described.Expert opinion: New strategies are currently under investigation to improve the outcome of this sometimes-devastating complication. Local delivery of antimicrobials seems to be a promising approach; however, further high-quality clinical research is necessary to demonstrate efficacy. Delivery mechanisms for local antimicrobials include polymethyl methacrylate, implant coatings, collagen fleece, hydrogels and ceramics. The reintroduction of antimicrobials such as bacteriophage therapy has demonstrated promise in the management of drug-resistant organisms. DOI: 10.1080/14787210.2020.1729740