Overview of empirical therapy for arthroplasty device infection in patients without symptoms or signs of sepsis or septic shock

For patients with an arthroplasty device infection who do not have symptoms or signs of sepsis or septic shock, empirical antibiotic treatment should usually be started after surgery to optimise the microbiological yield of surgical peri-prosthetic sampling—for discussion on investigations, see Investigations for arthroplasty device infection. However, surgical antibiotic prophylaxis should still be given at the usual time before skin incision.

The recommended empirical regimen targets the likely pathogens based on the classification of the infection. For empirical therapy regimens, see Early postoperative infection, Late acute infection or Late chronic infection.

For patients who have confirmed bacteraemia, directed antibiotic therapy should usually be started before the surgery. In particular, treatment for Staphylococcus aureus or Gram-negative bacteraemia must not be delayed as prompt therapy is associated with decreased mortality. For bacteraemia due to streptococci, coagulase-negative staphylococci and other organisms, seek infectious diseases or clinical microbiology advice on the timing of therapy.