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In patients taking antibiotics preoperatively buy eurax once a day acne in pregnancy, the sensitivity medical therapy in the majority of cases cheap eurax line skin care heaven coupon. These denitions may also prosthetic joint infectiona be useful for educating patients about the meaning and likelihood Category Description of a successful outcome prior to surgery buy discount eurax on line skin care routine quiz. The goal of each surgical strategy is Long term (10 yr or more) a to remove all infected tissue and hardware or to decrease the bur Based on data from reference 347. Antibiotics should be withheld until multiple intraop ment and immediate postoperative care occur in the hospital, in erative specimens are sent for microbiological analysis, unless the many hospitals, most of the antimicrobial treatment is given fol patient requires antimicrobials to treat a systemic infection. Accordingly, the best outcomes can be medical and surgical treatment strategies are outlined in Fig. Unfortunately, not all of prior surgical incision is opened, followed by irrigation and de these goals may be possible for every patient. The relative priori bridement of any necrotic or infected soft tissue, removal of any ties for each individual patient for pain relief, restoration of func encountered hematoma, and evacuation of any purulence sur tion, avoidance of prolonged antimicrobial therapy, and unwill rounding the prosthesis. Debridement must be thorough and ingness or inability to undergo surgery should be assessed and complete in order for this treatment strategy to succeed. The entire ing comparisons across different studies and management strate joint is then aggressively irrigated and closed, typically over a drain gies. One study found a 4-fold increase in the risk ity rate of 3 to 4% in large studies using debridement with implant of treatment failure when arthroscopic debridement was per retention (102, 103), and a mortality rate of 2% in large studies formed compared to an open procedure (349). Some investigators simply dene are held prior to surgery if the microbiology result is undeter success as freedom from signs or symptoms of infection at the mined. Broad-spectrum therapy is typically indicated in the im dened follow-up point, regardless of the required treatment (66, mediate postoperative period if the causative microorganism(s) 104, 346). However, other studies are more restrictive in the def and antimicrobial susceptibility test results are not known, given inition of treatment success. After pathogen identication and include the need for further revision surgery for any reason (101), antimicrobial susceptibility are dened, antimicrobial therapy can additional or suppressive antimicrobials beyond the initial treat be tailored. Most clinicians use intravenous antibiotics for the rst ment course (125, 176), or a nonfunctional arthroplasty (67). This Many clinicians use oral antibiotic suppressive therapy for paper also provides a temporal framework for treatment success. This is supported by the nding that the risk of provide a guide for future investigators and may serve to unify the failure increases 4-fold after antimicrobials are stopped, with most April 2014 Volume 27 Number 2 cmr. Outlined arrows indicate exchange of polyethylene components only, solid arrows indicate exchange of all arthroplasty components, and dotted arrows indicate exchange of cement spacer. There is debate among experts about the need for Ideally, the infecting pathogen should be susceptible to multiple and duration of suppressive therapy (60). When suppression is antimicrobials (353), but this may not be known when this surgi used, the duration may be indenite, or it may be limited to the cal strategy is selected. Surgery shortly after the onset of symptoms initial months or the rst year after surgery. High-quality data to is associated with a lower likelihood of treatment failure (102, support one particular antimicrobial strategy over another do not 355). Accordingly, early postoperative infections (occurring exist but may depend upon the virulence of the infecting patho within the rst month) or late acute hematogenous infections 324 cmr.
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