Analysis of risk factors leading to failure in septic two-stage exchange arthroplasty

Abstract

The aim of this habilitation script was to arm the treating physicians with an armamentarium of knowledge to achieve better success in eradicating PJI. Therefore, the published data concentrated on identification of the factors leading to failure in two-stage exchange arthroplasty in patients with PJI and on optimization of infection-free survival. Microbial biofilm makes the diagnosis and the treatment of PJI more challenging and therefore biofilm-active antibiotics are crucial to enhance treatment success. Microorganisms, for which no biofilm active antibiotic exits, presents a major difficulty in achieving high infect eradication rates in these patients. According to the results of this habilitation script however, an individualization of antimicrobial and surgical therapy regimes with a longer prothesis-free interval and longer antibiotic administration may enable achieving similar success rates in patients irrespective of causative microorganism after two-stage exchange arthroplasty. Furthermore, the data presented in this habilitation script emphasizes the implementation of a treatment supported by a multidisciplinary team approach as a crucial step to optimize outcome in patients with PJI. It could have been shown, that high infection eradication rates can be achieved by using a standardized two-stage exchange arthroplasty supported by a multidisciplinary team even in a challenging patient cohort. Given the fact, that there is a wide variety in the definition of PJI and its treatment success, which causes a heterogeneity of existing studies, further research is highly needed on more precisely defining PJI and success. Thus, consistency in definition between studies will enhance the overall quality of existing literature. Especially, when defining treatment success, it is important to distinguish between a new infection and an ongoing infection, as this prevent patients from unnecessary surgical interventions and antimicrobial treatment.