Septic Arthritis of Prosthetic Joints Empiric Therapy 

Updated: Apr 08, 2019
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Empiric Therapy Regimens

General recommendations and empiric therapeutic regimens for septic arthritis of prosthetic joints, or periprosthetic joint infection (PJI), are provided below, based on Gram stain results. [1, 2, 3, 4, 5, 6, 7]

It is difficult to differentiate aseptic loosening of prosthetic joints from low-grade-chronic periprosthetic joint infections. Measurement of circulating biomarkers code hold promise in making these determinations. The specificity of procalcitonin measurements is low in these situations (27.8%). The combination of a C-reactive protein (CRP) level [8] greater than 0.3 mg/dL and IL-6 level greater than 5.12 pg/mL is superior, with a sensitivity of 75% and specificity of 98.2% in high-risk patients. [9, 10]

General recommendations

Unless the clinical situation demands (ie, clinical sepsis), a culture should be obtained before initiating antibiotic therapy for PJI. [11]

Duration of antibiotic therapy is at least 6wk; some patients require indefinite antibiotic treatment.

Rifampin 600 mg PO q24h should be added for staphylococcal infections if hardware is retained. [1, 2, 3, 4, 5]

Negative or unavailable Gram stain

Vancomycin 15 mg/kg IV q12h plus ceftriaxone 1 g IV q24h

Gram-positive cocci in clusters

Vancomycin 15 mg/kg IV q12h

Gram-positive cocci in chains

Ampicillin 2 g IV q4h

Patients with penicillin allergy:

Vancomycin 15 mg/kg IV q12h

Gram-negative rods

Ceftriaxone 1 g IV q12h or

Cefepime 2 g IV q8h or

Piperacillin-tazobactam 3.375-4.5 g IV q6-8h

Patients with penicillin allergy:

Aztreonam 1-2 g IV q8h