Prosthetic joint infections
Usual Pathogens
Early (<3 months) after implant:
S. aureus
Coagulase negative Staphylococci (CoNS)
Enterobacterales
Polymicrobial
Delayed (3-24 months):
CoNS
Cutibacterium spp
Anaerobes (other)
S. aureus
Streptococcus spp
Late/Hematogenous (>2 years):
Streptococcus spp
Enterococcus spp
Abiotrophia spp
Granulicatella spp
S. aureus
CoNS
Enterobacterales
P. aeruginosa
Polymicrobial
Culture-negative
Fungi (rare)
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Withhold empiric antibiotic therapy prior to joint revision surgery unless patient is bacteremic or septic. | ||
| Culture-negative: | ||
| Vancomycin | 15mg/kg IV q12h | See Duration |
| + | ||
| Ceftriaxone |
1-2g IV daily | |
If surgery contraindicated:
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Vancomycin | 15mg/kg IV q12h | 4-6 weeks then long-term/life-long suppressive therapy (see below) |
| + | ||
| Ceftriaxone | 1-2g IV daily | |
| then |
Long-term/life-long suppressive therapy Strongly recommend ID consult
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Options include, but not limited to: | ||
| TMP/SMX | 1DS tab PO bid | |
| or | ||
| Doxycycline | 100mg PO bid | |
| or | ||
| Minocycline | 100mg PO bid | |