PeriproStenic Infection - Two-stage Treatment

Diagnosis

  • Clinic
  • Serological
  • Aspiration
  • Evaluation of joint fluid
OrganismNo.
Coagulase-negative staphylococci (Staph. Epidermidis)648 ➡️ %28 Gram (+)
Staphylococcus aureus636 ➡️ %28 Gram (+)
Streptococci, not A or D168
Anaerobic streptococci135
Pseudomonas131
Escherichia coli129
Enterococcus104
Corynebacterium (anaerobic)74
Proteus73
Propionibacterium acnes40
Klebsiella31
Enterobacter cloacae24
Diphtheroid22
Group A streptococcus17
Bacteroides fragilis12
Bacillus11
Candida8
Serratia8
Salmonella7
Tubercle bacteria6
Acinetobacter6
Aerobacter6
Other40

Methicilin resistance Glycocalyx(+) ➡️ Higher VIRULENCE!!! (Staphylococcus and Pseudomonas)

Gram (-) hematogenous infections (urinary)

Mixed infections – draining sinus (superinfection)

From Salvati EA, Della Valle AG, Masri BA, et al: The infected total hip arthroplasty, Instr Course Lect 52:223, 2003.

 

IntraoperativeSensitivitySpecificity
Surgeon’s impression(macroscopic)7087
Gram stain ☹1998
Frozen section ☺8094
Culture of tissue ☺ ☺ ☺9497
Swab culture ☺7699

Eklem aspirasyonu

  • 2 hafta önce antibiyotik kesilmeli
  • Serum konsantrasyonu
  • Hemen ekilmeli, gram boyama
  • En az 2 pozitif kültür
  • inovyal hücre sayımı

*Sinovyal CRP 9.5 mg/lt
**Lökosit esteraz (%81 sensitif, %100 spesifik)
***α- Defensin

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