Author/Editor		Trebše, Rihard; Pišot, Venčeslav; Trampuž, Andrej; Levašič, Vesna
Title		Rezultati zdravljenja okužb ortopedskih vsadkov s ciljanim antibiotičnim zdravljenjem in ohranitvijo vsadka
Translated title		Outcome of device-associated infections with antimicrobial treatment and implant retention
Type		članek
Source		In: Poljak M, editor. Zbornik predavanj Okužbe vsadkov; 2004 okt 8-9; Valdoltra. Ljubljana: Slovensko zdravniško društvo,
Publication year		2004
Volume		str. 87-98
Language		slo
Abstract		Background: Traditionally, management of device-associated infection includes removal of the implant, debridement, and long-term antimicrobial treatment. Increasing evidence suggests that success rates of > 80% can be achieved without device removal in the patients with stable implants receiving antimicrobial therapy directed against microbial biofilms. Methods: Over a 5-year period we prospectively evaluated the outcome of microbiologically confirmed infections associated with stable implants treated with device retention and a standardized antimicrobial protocol active against biofilms. Included were the patients with the duration of symptoms < 1 year, stable implant, good condition of surrounding tissue, and pathogen susceptible to antimicrobial agents anticipated in the treatment protocol. Findings: Included were 24 patients with device-associated infections. Most infections were caused by Staphylococcus aureus (46%), coagulase-negative staphylococci (25%), and streptococci (13%). The median age of the device atthe onset of infection was 32 months (range, 5 days-9 years) and the median duration of symptoms of infection was 108 days (range, 1-360 days). Twenty patients had a successful outcome during a median follow-up period of 2.7 years (range, 1.2-3.9 years], while in 4 patients device failure occurred after a median follow-up period of 1.1 years (range, 0.3-2.5 years). The probability of survival without treatment failure after 1, 2, and 3 years was 96% (95% confidence interval (CI). 88-100%), 91% (95% CI, 79-100%), and 82% (95% CI, 62-100%), respectively. Interpretation: Patients with a device-associated infection having a stable implant, known pathogen, and good condition of surrounding tissue can be successfully treated with device retention if antimicrobial agents active against biofilms are used.
Descriptors		PROSTHESIS-RELATED INFECTIONS BIOFILMS ANTIBIOTICS HIP PROSTHESIS KNEE PROSTHESIS TREATMENT OUTCOME