S. Houshian et al., Duration of postoperative antibiotic therapy following revision for infected knee and hip arthroplasties, SC J IN DIS, 32(6), 2000, pp. 685-688
In the period from 1990 to 1998 28 patients (14 males and 14 females) were
treated for infected hip (19 cases) and knee (9 cases) arthroplasties. The
median age at index operation was 72 y (range 31-82 y) and at revision surg
ery 74 y (range 36-83 y). The primary diagnosis was osteoarthritis (16 case
s), rheumatoid arthritis (5 cases), failed femoral neck fracture (6 cases)
and arthritis secondary to congenital hip dislocation (1 case). Nine cases
were infected early i.e. within 3 months postoperatively, and 19 had late i
nfections. The median interval from index operation to diagnosis of me infe
cted arthroplasty was 18 months (range 1-156 months). Postoperatively, all
patients received antibiotics based on susceptibility studies of the causat
ive organism according to culture specimens. The erthrocyte sedimentation r
ate and CRP level were controlled twice a week during hospitalization and a
ntibiotics were continued until normalization of CRP. The indication for th
e shift from intravenous to oral antibiotics was a rapid fall in CRP. Antib
iotic therapy was terminated when CRP was close to or below 10 mg/l and the
re was evidence of clinical recovery. Based on the screening of ESR and CRP
in this study we believe that CRP is a valuable parameter in deciding,when
to stop antibiotic therapy. However, it is not clear whether a shorter tre
atment period is effective or not.