Antibiotic-loaded cement spacer for treatment of Klebsiella infected total hip and knee arthroplasty
Background/Aim. Infection following total hip arthroplasty (THA) or total knee arthoplasty (TKA) may have devastating consequences. Some bacterial strains are often encountered as agents of these infections, others occur less frequently but are sometimes burdened with more severe complicati...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2014-01-01
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| Series: | Vojnosanitetski Pregled |
| Subjects: | |
| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2014/0042-84501400020B.pdf |
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| Summary: | Background/Aim. Infection following total hip arthroplasty (THA) or total
knee arthoplasty (TKA) may have devastating consequences. Some bacterial
strains are often encountered as agents of these infections, others occur
less frequently but are sometimes burdened with more severe complications.
Klebsiella spp. are uncommon causes of THA or TKA infection. The aim of this
study was to identify an effective treatment algorithm for multidrug
resistant Klebsiella spp. caused THA or TKA infections. Methods. During the
3-year period, from January 1 2009 to December 31 2011, we registered and
treated 5 patients with THA or TKA multidrug resistant Klebsiella spp. caused
infection. All the patients were primarily operated in other institutions,
and were admitted in our clinic after the onset of infection symptoms. In
three of the cases Klebsiella infection was complicated by additional
infection (Staphyloccocus aureus, Pseudomonas aeruginosa and Serratia
marscescens). In 3 of the cases we performed revision arthroplasty after
double exchange of antibiotic-loaded articulating cement spacer, and in 2 of
the cases the standard two stage revision approach with one antibiotic cement
spacer exchange was applied. Results. The mean length of follow-up after
reimplantation surgery was 17.1 months (range 2-31 months). One patient died
2 months after the final reimplantation procedure. The initial Klebsiella
infection was eradicated in all patients. At the end follow-up after
definitive reimplantation, patients had no clinical, laboratory or
microbiological parameters positive for active infection. Conclusion.
According to our experience with multidrug-resistant Klebsiella TKA/THA
infections, two-stage approach, in some cases with double articulating cement
spacer exchange prior to definitive reimplantation, is the most effective
treatment option. |
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| ISSN: | 0042-8450 |