Journal of Bone and Joint Infection
Journal of Bone and Joint Infection
JBJI
Articles | Volume 6, issue 7
Articles | Volume 6, issue 7
https://doi.org/10.5194/jbji-6-305-2021
© Author(s) 2021. This work is distributed under
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-6-305-2021
© Author(s) 2021. This work is distributed under
the Creative Commons Attribution 4.0 License.
Articles | Volume 6, issue 7
Original full-length article
 | 
10 Aug 2021
Original full-length article |  | 10 Aug 2021

Combined antibiotic therapy spacers either commercial or handmade are superior to monotherapy – a microbiological analysis at the second stage of revision

André Dias Carvalho, Ana Ribau, Daniel Soares, Ana Claudia Santos, Miguel Abreu, and Ricardo Sousa

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Cited articles

Akgun, D., Müller, M., Perka, C., and Winkler, T.: A positive bacterial culture during re-implantation is associated with a poor outcome in two-stage exchange arthroplasty for deep infection, Bone Joint J., 99, 1490–1495, https://doi.org/10.1302/0301-620X.99B11.BJJ-2017-0243-R1, 2017. 
Cui, Q., Mihalko, W., Shields, J. S., Ries, M., and Saleh, K. J.: Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty, J. Bone Joint Surg. Am., 89, 871–882, 2007. 
Gehrke, T. and Parvizi, J.: Proceedings of the International Consensus Meeting on Periprosthetic Joint Infection, available at: https://www.efort.org/wp-content/uploads/2013/10/Philadelphia_Consensus.pdf (last access: 1 March 2021), 2013. 
George, J., Kwiecien, G., Klika, A. K., Ramanathan, D., Bauer, T. W., Barsoum, W. K., and Higuera, C. A.: Are Frozen Sections and MSIS Criteria Reliable at the Time of Reimplantation of Two-stage Revision Arthroplasty?, Clin. Orthop. Relat. Res., 474, 1619–1626, 2016. 
Goltzer, O., McLaren, A., Overstreet, D., Galli, C., and McLemore, R.: Antimicrobial Release From Prefabricated Spacers Is Variable and the Dose Is Low, Clin. Orthop. Relat. Res., 473, 2253–2261, 2015. 
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Short summary
When we initiated this paper, there was no evidence on what kind of spacers we should use. Our work was to prove that we must use a broad spectrum of antibiotics at the spacers in two-stage revision procedures. We demonstrate that a large spectrum of antibiotics at the spacer results in a lower rate of positive cultures during preimplantation and, subsequently, better outcomes and lower rate of infection.
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