The microbiology of the infected knee arthroplasty

Abstract

We describe the results of a retrospective analysis of patients with microbiologically proven infection, who underwent revision TKA between 1994 and 2008. Of the 121 patients included in the study, 61 (50%) were male and 60 (50%) were female. The mean age was 71 (range 42-88) years. The most common organisms identified were Coagulase negative Staphylococcus (CNS) (49%) and Staphylococcus aureus (SA) (13%). The prevalence of CNS appears to be increasing, while that of SA and other organisms is decreasing. Vancomycin and teicoplanin were the most effective antibiotics with overall sensitivity rates of 100% and 96%, respectively. The results of our theoretical model suggest that gentamicin combined with vancomycin is the most effective empirical regimen. Staphylococcal species are the most common organisms encountered in deep infection of the knee. Gentamicin combined with vancomycin offers the most comprehensive protection and potentially allows for infected knee arthoplasties to be treated with a one-stage procedure.

Figures

Fig. 1

Changing pattern of microbiology, 1994–2008

Fig. 2

Sensitivities of all organisms to antibiotics

Fig. 3

Sensitivity of Coagulase negative Staphylococcus (CNS) and Staphylococcus aureus (SA) to antibiotics

Fig. 4

Changing sensitivity of Coagulase negative Staphylococcus (CNS) to antibiotics, 1994–2008

Fig. 5

Combination of gentamicin and other antibiotics to staphylococcal species