Breakpoints #67 – Nixing the Nidus: Managing Retained Sources in Prosthetic Joint Infections
Nov 25, 2022
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Biofilm Challenges in PJI
- Biofilms form quickly on bone and prosthetic surfaces in prosthetic joint infections (PJI).
- Bacteria in biofilms are much harder to eradicate due to antibiotic tolerance and immune evasion.
Longer Therapy Needed with Retained Hardware
- Retained prosthetic devices tend to harbor biofilms requiring longer antibiotic therapy.
- The DATIPO trial showed 12 weeks of antibiotics is superior to 6 weeks after debridement with implant retention.
Antibiotic Efficacy Differs in Biofilm
- Cell wall-acting antibiotics like vancomycin and beta-lactams are less effective against biofilm bacteria.
- Antibiotics like rifampin, daptomycin, and doxycycline often have better activity in PJI biofilms.