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World J Clin Infect Dis. Aug 25, 2014; 4(3): 9-15
Published online Aug 25, 2014. doi: 10.5495/wjcid.v4.i3.9
Prosthetic joint infections-a clinico-microbiological perspective: Review article
Pravin K Nair, Vivek G Bhat, Michelle S Vaz
Pravin K Nair, Michelle S Vaz, Department of Microbiology, Holy Spirit Hospital, Andheri (E), Mumbai 400093, India
Vivek G Bhat, Department of Microbiology, ACTREC-Tata Memorial Center, Navi Mumbai 410210, India
Author contributions: All the authors contributed equally to the work in literature survey and writing of the paper.
Correspondence to: Vivek G Bhat, MD, Associate Professor-Microbiology, Advanced Centre for Treatment, Research and Education in Cancer, Department of Microbiology, ACTREC-Tata Memorial Centre, Navi Mumbai 410210, India.
Telephone: +91-22-27405093 Fax: +91-22-27405061
Received: June 24, 2014
Revised: July 21, 2014
Accepted: August 20, 2014
Published online: August 25, 2014

Prosthetic joint infections (PJIs), although not very common, currently pose a very significant threat since they are associated with severe complications, high morbidity rates and substantial costs. PJIs are most commonly caused by Staphylococcus aureus and coagulase-negative staphylococci. The diagnosis of implant-associated infections is very challenging since no single routinely used laboratory or clinical test has been shown to demonstrate adequate results with respect to sensitivity, specificity and accuracy. In most cases, a sum of clinical signs and symptoms, histopathology, blood tests, radiography, bone scans and microbiological testing is considered to arrive at an accurate diagnosis. Treatment of PJIs is also very difficult since most of the infections are caused by biofilm-producing microorganisms which are significantly more resistant to the hosts natural defense mechanisms and antibiotic treatment. For successful management, a combination of both antibiotic and surgical treatment is most often required, and early diagnosis is of the utmost importance. Thus, a multidisciplinary approach is potentially the best option in dealing with PJI, and should include the involvement of microbiologists, orthopedic specialists, clinicians, pathologists and radiologists in order to improve decision-making processes and ensure overall success. The following review aims at briefly outlining the microbiology, diagnostic and treatment options, and preventive measures associated with such infections.

Keywords: Prosthetic joint infections, Biofilms, Diagnosis, Antimicrobial therapy, Surgical treatment

Core tip: Prosthetic joint infections (PJIs), although uncommon, may be associated with significant complications and morbidity. Staphylococci are among the most commonly involved organisms. Diagnosis may be challenging in spite of the availability of various laboratory and radiological tests. Treatment too, is often difficult because most infections are caused by biofilm producing organisms. A combination of prudent surgical intervention and specific antibiotic treatment is the key to a successful management. Thus, a multidisciplinary approach is the best option in dealing with PJI, and should involve a team of orthopedic specialists, clinicians, pathologists, radiologists and microbiologists to ensure best outcomes.