Infections after Anterior Cruciate Ligament Reconstruction: Which Antibiotic after Arthroscopic Debridement?
Abstract
Arthroscopic debridement has proven to be the optimal surgical treatment for infections of the anterior cruciate ligament reconstruction (ACLR). Nevertheless, there are no reported data for the best antibiotic treatment option and its duration. The purpose of this article is to assess the usefulness of oral levofloxacin and rifampicin for the treatment of acute infections of an ACLR. This is a retrospective observational cohort study of patients operated on for ACLR over 4 years. A diagnosis of septic arthritis was based on patients' anamnesis and physical examination, laboratory parameters, and cultures of synovial fluid and/or joint tissue. Arthroscopic lavage was performed as soon as possible and tissue samples were taken. At a minimum 2-year follow-up, the infection was considered cured with a normal C-reactive protein (CRP) level and a correctly functioning and pain-free knee. Of the 810 patients, 15 (1.8%) were diagnosed as having an infection. Among the 13 staphylococcal cases (86.6%), 10 were susceptible to both quinolones and rifampicin (76.9% of the staphylococcal infections). There were two staphylococci that were rifampicin resistant. In the remaining one case, the coagulase-negative staphylococcus (CNS) was resistant to quinolones. One CNS infection was treated with linezolid and rifampicin and was the only case that needed graft removal due to treatment failure. Antibiotic treatment lasted an average of 6 weeks and oral treatment started at a mean of 5 days…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 810 participants or records.
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