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Two-Stage PJI Antibiotic Duration — SCE Infectious Diseases MCQ

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ModerateBone & Joint InfectionTwo-Stage PJI Antibiotic DurationSCE Infectious Diseases

A 60-year-old man develops a prosthetic knee joint infection 5 years after primary total knee replacement. He presents with 2 months of knee pain with a draining sinus. Culture of deep tissue samples grows Staphylococcus epidermidis (methicillin-resistant). What duration of antibiotic therapy is recommended after two-stage revision arthroplasty?

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Correct answer: C — 6 weeks of targeted IV/oral antibiotics after stage 1 (prosthesis removal); a shorter 5-day perioperative course at stage 2 (reimplantation) is standard in many centres

In two-stage revision for chronic PJI: Stage 1 (prosthesis removal, debridement, spacer insertion) is followed by 6 weeks of targeted antibiotics. The antibiotic-free interval before Stage 2 (reimplantation) varies by centre (some use 2-week antibiotic holiday, others proceed directly). At Stage 2, a short perioperative course (typically 5 days of IV antibiotics) is standard. Some centres extend post-Stage 2 antibiotics to 6 weeks, particularly for virulent organisms. The key principle is that the 6-week post-Stage 1 course aims to sterilise the infection before reimplantation.

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