The pathogenesis of implant-associated
infection involves interaction between the microorganisms (biofilm formation), the implant and the host. Despite improvement of perioperative prophylaxis, orthopaedic implants still remain highly susceptible to bacterial or fungal contamination, generally resulting in persistent implant-associated
infection. Therefore, perioperative and life-long prevention of
infection is important. For perioperative prophylaxis, a first- or
second-generation cephalosporin is recommended, which should be administered between 60 and 30 minutes before incision. The duration of prophylaxis should not exceed 1 day. In centres with a low incidence of
infection, a single dose is sufficient. Treatment of
infections associated with orthopaedic devices usually requires appropriate surgical intervention combined with prolonged antimicrobial
therapy. The choice of the antimicrobial regimen depends on the duration and pathogenesis of
infection, stability of the implant, antimicrobial susceptibility of the pathogen and condition of the surrounding soft tissue. The role of
rifampicin (
rifampin), which has excellent activity on adherent staphylococci, in combination with
beta-lactams,
glycopeptides,
fluoroquinolones,
minocycline,
cotrimoxazole or
fusidic acid, in the treatment of
staphylococcal infections is outlined. Increasing antimicrobial resistance requires the use of alternative agents, such as
quinupristin/dalfopristin,
linezolid and
daptomycin, but results of clinical trials with these agents are limited. Also reviewed are potential new
antimicrobial agents currently undergoing investigation, such as the novel
oxazolidinone RWJ-416457, the new
glycopeptide dalbavancin, the
glycylcycline compound
tigecycline, the new carbacephem BP-102 and novel
rifamycin derivatives. Vaccination against Staphylococcus aureus with
StaphVAX induced specific
antibodies potentially preventing bacteraemia; however, there are no studies on efficacy in the prophylaxis of device-associated
infections with this
vaccine.