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J Infect. 2015 Jan;70(1):30-6. doi: 10.1016/j.jinf.2014.07.008. Epub 2014 Jul 28.

Factors related to outcome of early and delayed prosthetic joint infections.

Author information

  • 1Department of Infectious Diseases, D. Cotugno Hospital, AORN Dei Colli, Naples, Italy. Electronic address:
  • 2Department of Infectious Diseases, D. Cotugno Hospital, AORN Dei Colli, Naples, Italy.
  • 3Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy.
  • 4Department of Orthopaedic Surgery, C.T.O. Hospital, AORN Dei Colli, Naples, Italy.
  • 5Department of Orthopaedic Surgery, Sarno Hospital, Sarno, Italy.
  • 6Department of Orthopaedic Surgery, "S. Michele" Clinic, Maddaloni, Italy.
  • 7Department of Microbiology, AORN Dei Colli, Naples, Italy.
  • 8Department of Infectious Diseases, University of Salerno, Italy.


In this prospective study, we evaluate the impact of adherence to a diagnostic and therapeutic protocol on prosthetic joint infections (PJI) diagnostic accuracy and outcome.


Patients with early or delayed PJI referred over a 5-year period were included. Diagnosis was based on characteristic clinical signs, radiographic findings and microbiological evidence. Antibiotics were chosen on the basis of microbiological findings, and drugs active against methicillin-resistant staphylococci were administered if no microbiological evidence had been obtained.


Inclusion criteria were met in 159 cases (median age 64 years, males 45%). 56 were early infections and 103 delayed infections. Comorbidities were reported in 99 (62%) cases. Positive cultures were obtained in 122/159 (77%), coagulase-negative staphylococci were cultured in 20%, Staphylococcus aureus in 28%, and Pseudomonas aeruginosa in 7%. In early infections, cure rate after debridement and antibiotic therapy was 80%. In delayed infections, cure rate after two-stage exchange was 85%. Of 28 patients with delayed infection treated with antibiotics without surgery, only 8 (29%) infections were suppressed 48 weeks after treatment discontinuation. Rifampin afforded a better outcome.


Appropriate diagnostic and surgical procedures and microbiologically driven antibiotic therapy including rifampin are recommended to improve diagnostic accuracy and outcome.

Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.


Diagnosis; Infection; Prosthetic joint infections; Surgical implant; Treatment

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