(p. 227) Staphylococcal prosthetic joint infection 

Prosthetic joint infection (PJI) is a catastrophic complication and the majority of cases are caused by coagulase-negative staphylococci or Staphylococcus aureus. Staphylococci adhere to native bone and prostheses and can form biofilms to protect against the host immune response and antibiotic penetration. Diagnosis may be difficult in the absence of fever and raised inflammatory markers, and radiology findings are often non-specific. A microbiological diagnosis may be obtained by tissue cultures or newer techniques such as sonication and PCR. The infection in the case was identified as methicillin-sensitive Staphylococcus aureus (MSSA). Different surgical strategies available to manage prosthetic joint infection are discussed including one- and two-stage revision arthroplasty, DAIR (debridement, antibiotics, and implant retention), and the use of antibiotic-eluting spacers and cement. There is controversy regarding the choice, duration, and route of administration of antibiotic therapy and whether prolonged systemic therapy is required at all. PJI creates a significant economic burden and infection control procedures are imperative to reduce the impact on patients and healthcare resources.