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Prosthetic Joint Infection — SCE Infectious Diseases MCQ

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HardBone & Joint InfectionProsthetic Joint InfectionSCE Infectious Diseases

A 55-year-old woman undergoes right hip replacement. On post-operative day 3, she develops fever, wound erythema, and purulent discharge. Wound swab culture grows Staphylococcus aureus (MSSA). CRP is 280 mg/L. The prosthesis was inserted 72 hours ago. What is the optimal surgical and antimicrobial strategy?

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Correct answer: A — DAIR (debridement, antibiotics, and implant retention) plus IV Flucloxacillin and Rifampicin for 6 weeks then oral step-down

For early prosthetic joint infection (within 3 months of implantation, or acute onset with symptoms <3 weeks), DAIR is the recommended approach if the prosthesis is well-fixed, soft tissues are viable, and the organism is susceptible to biofilm-active antibiotics. The regimen includes IV Flucloxacillin (for MSSA) plus oral Rifampicin (anti-biofilm agent, started after blood cultures are clear) for an initial IV phase, then oral switch to a fluoroquinolone plus Rifampicin for a total of 3–6 months. Two-stage revision is reserved for late/chronic PJI.

Reference: BSAC 2023 – PJI guidelines; NICE NG157 2024 – Joint replacement infections