Drugs & Aging

, Volume 25, Issue 5, pp 399–414 | Cite as

Surgical Site Infections in Older Adults

Epidemiology and Management Strategies
  • Michael H. Young
  • Laraine Washer
  • Preeti N. Malani
Review Article


Surgical site infections (SSIs) represent a major source of morbidity and mortality among older adults. In this review we discuss the epidemiology and risk factors for SSIs among older adults. We also offer an overview of current treatment and management strategies for several common SSIs. Our comments focus on the following areas in order to illustrate issues of clinical importance in the older patient: (i) cardiac surgery; (ii) vascular grafts; (iii) total joint arthroplasty; (iv) breast surgery; and (v) spinal surgeries. Besides being common and relatively specific to older adults, several of these surgical procedures require the use of prosthetic materials or devices, which present unique treatment challenges in the context of infection. When an older adult does develop an SSI, it is critical for clinicians to establish an overall treatment goal for each patient. In the majority of patients, this will be either complete cure or remission followed by suppressive therapy. However, clinicians caring for older adults must consider not only the possibility of microbiological cure, but also balance the need to preserve functional status and overall quality of life. Infections associated with devices and prosthetic material can present unique treatment challenges. Treatment of significant infections often requires prolonged courses of parenteral and/or oral antimicrobial therapy, which can raise issues related to the safety and tolerability of antimicrobial agents, including higher rates of nephrotoxicity. Issues concerning overall functional status, nutritional reserve and medical co-morbidities must be taken into consideration when approaching SSIs in an older adult.


Surgical Site Infection Saphenous Vein Graft Mupirocin Prosthetic Joint Infection National Nosocomial Infection Surveillance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported in part by VA Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center (GRECC) and the John A. Hartford Foundation’s Center of Excellence. No other sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.


  1. 1.
    Bacchetta MD, Ko W, Girardi LN, et al. Outcomes of cardiac surgery in nonagenarians: a 10-year experience. Ann Thorac Surg 2003; 75(4): 1215–20PubMedCrossRefGoogle Scholar
  2. 2.
    Chukwuemeka A, Borger MA, Ivanov J, et al. Valve surgery in octogenarians: a safe option with good medium-term results. J Heart Valve Dis 2006; 15(2): 191–6; discussion 196PubMedGoogle Scholar
  3. 3.
    Collart F, Feier H, Kerbaul F, et al. Primary valvular surgery in octogenarians: perioperative outcome. J Heart Valve Dis 2005; 14(2): 238–42; discussion 242PubMedGoogle Scholar
  4. 4.
    Fowler Jr VG, O’Brien SM, Muhlbaier LH, et al. Clinical predictors of major infections after cardiac surgery. Circulation 2005; 112(9 Suppl.): 1358–65Google Scholar
  5. 5.
    National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32(8): 470–85Google Scholar
  6. 6.
    Paletta CE, Huang DB, Fiore AC, et al. Major leg wound complications after saphenous vein harvest for coronary revascularization. Ann Thorac Surg 2000; 70(2): 492–7PubMedCrossRefGoogle Scholar
  7. 7.
    Rupp M. Mediastinitis. In: Mandell G, Douglass R, Dolin R, editors. Principles and practice of infectious diseases. 6th ed. Philadelphia (PA): Churchill-Livingstone, 2005: 1070–8Google Scholar
  8. 8.
    Mayhall C. Hospital epidemiology and infection control. In: Lew P, Pittet D, Walvogel F, editors. Infections that complicate the insertion of prosthetic devices. 3rd ed. Philadelphia (PA): Lippincott Williams and Wilkins, 2004: 287–310Google Scholar
  9. 9.
    Trouillet JL, Vuagnat A, Combes A, et al. Acute poststernotomy mediastinitis managed with debridement and closed-drainage aspiration: factors associated with death in the intensive care unit. J Thorac Cardiovasc Surg 2005; 129(3): 518–24PubMedCrossRefGoogle Scholar
  10. 10.
    Marggraf G, Splittgerber FH, Knox M, et al. Mediastinitis after cardiac surgery: epidemiology and current treatment. Eur J Surg Suppl 1999; (584): 12–6Google Scholar
  11. 11.
    Tang AT, Ohri SK, Haw MP. Novel application of vacuum assisted closure technique to the treatment of sternotomy wound infection. Eur J Cardiothorac Surg 2000; 17(4): 482–4PubMedCrossRefGoogle Scholar
  12. 12.
    Culver DH, Horan TC, Gaynes RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index: National Nosocomial Infections Surveillance system. Am J Med 1991; 91(3B): 152S–7SPubMedCrossRefGoogle Scholar
  13. 13.
    Borger MA, Rao V, Weisel RD, et al. Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg 1998; 65(4): 1050–6PubMedCrossRefGoogle Scholar
  14. 14.
    Harrington G, Russo P, Spelman D, et al. Surgical-site infection rates and risk factor analysis in coronary artery bypass graft surgery. Infect Control Hosp Epidemiol 2004; 25(6): 472–6PubMedCrossRefGoogle Scholar
  15. 15.
    Bitkover CY, Gardlund B. Mediastinitis after cardiovascular operations: a case-control study of risk factors. Ann Thorac Surg 1998; 65(1): 36–40PubMedCrossRefGoogle Scholar
  16. 16.
    Lepelletier D, Perron S, Bizouarn P, et al. Surgical-site infection after cardiac surgery: incidence, microbiology, and risk factors. Infect Control Hosp Epidemiol 2005; 26(5): 466–72PubMedCrossRefGoogle Scholar
  17. 17.
    Garey KW, Kumar N, Dao T, et al. Risk factors for postoperative chest wound infections due to gram-negative bacteria in cardiac surgery patients. J Chemother 2006; 18(4): 402–8PubMedGoogle Scholar
  18. 18.
    Wong E. Surgical site infections. In: Mayhall C, editor. Hospital epidemiology and infection control. Philadelphia (PA): Lippincott Williams and Wilkins, 2004: 287–310Google Scholar
  19. 19.
    Banbury MK, Brizzio ME, Rajeswaran J, et al. Transfusion increases the risk of postoperative infection after cardiovascular surgery. J Am Coll Surg 2006; 202(1): 131–8PubMedCrossRefGoogle Scholar
  20. 20.
    Torres S, Kuo YH, Morris K, et al. Intravenous iron following cardiac surgery does not increase the infection rate. Surg Infect (Larchmt) 2006; 7(4): 361–6CrossRefGoogle Scholar
  21. 21.
    Basaran M, Selimoglu O, Ozcan H, et al. Being an elderly woman: is it a risk factor for morbidity after coronary artery bypass surgery? Eur J Cardiothorac Surg 2007; 32(1): 58–64PubMedCrossRefGoogle Scholar
  22. 22.
    Paul M, Raz A, Leibovici L, et al. Sternal wound infection after coronary artery bypass graft surgery: validation of existing risk scores. J Thorac Cardiovasc Surg 2007; 133(2): 397–403PubMedCrossRefGoogle Scholar
  23. 23.
    Kaye KS, Schmader KE, Sawyer R. Surgical site infection in the elderly population. Clin Infect Dis 2004; 39(12): 1835–41PubMedCrossRefGoogle Scholar
  24. 24.
    Olsen MA, Lock-Buckley P, Hopkins D, et al. The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. J Thorac Cardiovasc Surg 2002; 124(1): 136–45PubMedCrossRefGoogle Scholar
  25. 25.
    Mishriki SF, Law DJ, Jeffery PJ. Factors affecting the incidence of postoperative wound infection. J Hosp Infect 1990; 16(3): 223–30PubMedCrossRefGoogle Scholar
  26. 26.
    Edwards FH, Engelman RM, Houck P, et al. The Society of Thoracic Surgeons practice guideline series: antibiotic prophylaxis in cardiac surgery. Part I: duration. Ann Thorac Surg 2006; 81: 397–404CrossRefGoogle Scholar
  27. 27.
    Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004; 38(12): 1706–15PubMedCrossRefGoogle Scholar
  28. 28.
    Latham R, Lancaster AD, Covington JF, et al. The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infect Control Hosp Epidemiol 2001; 22(10): 607–12PubMedCrossRefGoogle Scholar
  29. 29.
    Furnary AP, Zerr KJ, Grunkemeier GL, et al. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg 1999; 67(2): 352–60; discussion 360–2PubMedCrossRefGoogle Scholar
  30. 30.
    Segers P, Speekenbrink RG, Ubbink DT, et al. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. JAMA 2006; 296(20): 2460–6PubMedCrossRefGoogle Scholar
  31. 31.
    Kluytmans JA, Mouton JW, VandenBergh MF, et al. Reduction of surgical-site infections in cardiothoracic surgery by elimination of nasal carriage of Staphylococcus aureus. Infect Control Hosp Epidemiol 1996; 17(12): 780–5PubMedCrossRefGoogle Scholar
  32. 32.
    Trautmann MJ, Stecher W, Hemmer K, et al. Intranasal mupirocin prophylaxis in elective surgery: a review of published studies. Chemotherapy 2008; 54: 9–16PubMedCrossRefGoogle Scholar
  33. 33.
    Cimochowski GE, Harostock MD, Brown R, et al. Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics. Ann Thorac Surg 2001; 71: 1572–8PubMedCrossRefGoogle Scholar
  34. 34.
    Usry GH, Johnson L, Weems JJ, et al. Process improvement plan for the reduction of sternal surgical site infections among patients undergoing artery bypass graft surgery. Am J Infect Control 2002; 30: 434–6PubMedCrossRefGoogle Scholar
  35. 35.
    Nicholson MR, Huesman LA. Controlling usage of intranasal mupirocin does impact the rate of Staphylococcus aureus deep sternal wound infections in cardiac surgery patients. Am J Infect Control 2006; 34: 44–8PubMedCrossRefGoogle Scholar
  36. 36.
    Konvalinka A, Errett L, Fong IW. Impact of treating Staphylococcus aureus nasal carriers on wound infections in cardiac surgery. J Hosp Infect 2006; 64(2): 162–8PubMedCrossRefGoogle Scholar
  37. 37.
    Perl TM, Cullen JJ, Wenzel RP, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002; 346(24): 1871–7PubMedCrossRefGoogle Scholar
  38. 38.
    Baddour LM, Wilson WR. Chapter 75: infections of prosthetic valves and other cardiovascular devices. In: Mandell G, Douglass R, Dolin R, editors. Principles and practice of infectious diseases. 6th ed. Philadelphia (PA): Churchill-Livingstone, 2005: 1038–9Google Scholar
  39. 39.
    Chang JK, Calligaro KD, Ryan S, et al. Risk factors associated with infection of lower extremity revascularization: analysis of 365 procedures performed at a teaching hospital. Ann Vasc Surg 2003; 17(1): 91–6PubMedCrossRefGoogle Scholar
  40. 40.
    Ryan SV, Calligaro KD, Scharff J, et al. Management of infected prosthetic dialysis arteriovenous grafts. J Vasc Surg 2004; 39(1): 73–8PubMedCrossRefGoogle Scholar
  41. 41.
    Calligaro KD, Veith FJ, Schwartz ML, et al. Selective preservation of infected prosthetic arterial grafts: analysis of a 20-year experience with 120 extracavitary-infected grafts. Ann Surg 1994; 220(4): 461–9; discussion 469–71PubMedCrossRefGoogle Scholar
  42. 42.
    Edwards Jr WH, Martin 3rd RS, Jenkins JM, et al. Primary graft infections. J Vasc Surg 1987; 6(3): 235–9PubMedGoogle Scholar
  43. 43.
    Jensen LJ, Kimose HH. Prosthetic graft infections: a review of 720 arterial prosthetic reconstructions. Thorac Cardiovasc Surg 1985; 33(6): 389–91PubMedCrossRefGoogle Scholar
  44. 44.
    Mertens RA, O’Hara PJ, Hertzer NR, et al. Surgical management of infrainguinal arterial prosthetic graft infections: review of a thirty-five-year experience. J Vasc Surg 1995; 21(5): 782–90; discussion 790–1PubMedCrossRefGoogle Scholar
  45. 45.
    Taylor MD, Napolitano LM. Methicillin-resistant Staphylococcus aureus infections in vascular surgery: increasing prevalence. Surg Infect (Larchmt) 2004; 5(2): 180–7Google Scholar
  46. 46.
    Calligaro KD, Syrek JR, Dougherty MJ, et al. Use of arm and lesser saphenous vein compared with prosthetic grafts for infrapopliteal arterial bypass: are they worth the effort? J Vasc Surg 1997; 26(6): 919–24; discussion 925–7PubMedCrossRefGoogle Scholar
  47. 47.
    Lee ES, Santilli SM, Olson MM, et al. Wound infection after infrainguinal bypass operations: multivariate analysis of putative risk factors. Surg Infect (Larchmt) 2000; 1(4): 257–63CrossRefGoogle Scholar
  48. 48.
    Pedersen G, Laxdal E, Hagala M, et al. Local infections after above-knee prosthetic femoropopliteal bypass for intermittent claudication. Surg Infect (Larchmt) 2004; 5(2): 174–9CrossRefGoogle Scholar
  49. 49.
    Antonios VS, Noel AA, Steckelberg JM, et al. Prosthetic vascular graft infection: a risk factor analysis using a case-control study. J Infect 2006; 53(1): 49–55PubMedCrossRefGoogle Scholar
  50. 50.
    Fiorani P, Speziale F, Calisti A, et al. Endovascular graft infection: preliminary results of an international enquiry. J Endovasc Ther 2003; 10(5): 919–27PubMedCrossRefGoogle Scholar
  51. 51.
    Vriesendorp TM, Morelis QJ, Devries JH, et al. Early postoperative glucose levels are an independent risk factor for infection after peripheral vascular surgery: a retrospective study. Eur J Vasc Endovasc Surg 2004; 28(5): 520–5PubMedCrossRefGoogle Scholar
  52. 52.
    Calligaro KD, Veith FJ, Schwartz ML, et al. Recommendations for initial antibiotic treatment of extracavitary arterial graft infections. Am J Surg 1995; 170(2): 123–5PubMedCrossRefGoogle Scholar
  53. 53.
    Collazos J, Mayo J, Martinez E, et al. Prosthetic vascular graft infection due to Aspergillus species: case report and literature review. Eur J Clin Microbiol Infect Dis 2001; 20(6): 414–7PubMedGoogle Scholar
  54. 54.
    Lephart P, Ferrieri P, van Burik JA. Reservoir of Candida albicans infection in a vascular bypass graft demonstrates a stable karyotype over six months. Med Mycol 2004; 42(3): 255–60PubMedCrossRefGoogle Scholar
  55. 55.
    Matthay RA, Levin DC, Wicks AB, et al. Disseminated histoplasmosis involving an aortofemoral prosthetic graft. JAMA 1976; 235(14): 1478–9PubMedCrossRefGoogle Scholar
  56. 56.
    Raffetto JD, Bernardo J, Menzoian JO. Aortobifemoral graft infection with Mycobacterium tuberculosis: treatment with abscess drainage, debridement, and long-term administration of antibiotic agents. J Vasc Surg 2004; 40(4): 826–9PubMedCrossRefGoogle Scholar
  57. 57.
    Nasim A, Thompson MM, Naylor AR, et al. The impact of MRSA on vascular surgery. Eur J Vasc Endovasc Surg 2001; 22(3): 211–4PubMedCrossRefGoogle Scholar
  58. 58.
    FitzGerald SF, Kelly C, Humphreys H. Diagnosis and treatment of prosthetic aortic graft infections: confusion and inconsistency in the absence of evidence or consensus. J Antimicrob Chemother 2005; 56(6): 996–9PubMedCrossRefGoogle Scholar
  59. 59.
    Rossi P, Arata FM, Salvatori FM, et al. Prosthetic graft infection: diagnostic and therapeutic role of interventional radiology. J Vasc Interv Radiol 1997; 8(2): 271–7PubMedCrossRefGoogle Scholar
  60. 60.
    Thomas P, Forstrom L. In-111 labeled purified granulocytes in the diagnosis of synthetic vascular graft infections. Clin Nucl Med 1994; 19(12): 1075–8PubMedCrossRefGoogle Scholar
  61. 61.
    Seify H, Moyer HR, Jones GE, et al. The role of muscle flaps in wound salvage after vascular graft infections: the Emory experience. Plast Reconstr Surg 2006; 117(4): 1325–33PubMedCrossRefGoogle Scholar
  62. 62.
    Calligaro KD, Veith FJ, Schwartz ML, et al. Differences in early versus late extracavitary arterial graft infections. J Vasc Surg 1995; 22(6): 680–5; discussion 685–8PubMedCrossRefGoogle Scholar
  63. 63.
    O’Connor S, Andrew P, Batt M, et al. A systematic review and meta-analysis of treatments for aortic graft infection. J Vasc Surg 2006; 44(1): 38–45PubMedCrossRefGoogle Scholar
  64. 64.
    Young RM, Cherry Jr KJ, Davis PM, et al. The results of in situ prosthetic replacement for infected aortic grafts. Am J Surg 1999; 178(2): 136–40PubMedCrossRefGoogle Scholar
  65. 65.
    Kurtz S, Mowat F, Ong K, et al. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005; 87(7): 1487–97PubMedCrossRefGoogle Scholar
  66. 66.
    Lentino JR. Prosthetic joint infections: bane of orthopedists, challenge for infectious disease specialists. Clin Infect Dis 2003; 36(9): 1157–61PubMedCrossRefGoogle Scholar
  67. 67.
    Sia IG, Berbari EF, Karchmer AW. Prosthetic joint infections. Infect Dis Clin North Am 2005; 19(4): 885–914PubMedCrossRefGoogle Scholar
  68. 68.
    Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty: a study of the treatment of one hundred and six infections. J Bone Joint Surg Am 1996; 78(4): 512–23PubMedGoogle Scholar
  69. 69.
    Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med 2004; 351(16): 1645–54PubMedCrossRefGoogle Scholar
  70. 70.
    Murdoch DR, Roberts SA, Fowler Jr VG, et al. Infection of orthopedic prostheses after Staphylococcus aureus bacteremia. Clin Infect Dis 2001; 32(4): 647–9PubMedCrossRefGoogle Scholar
  71. 71.
    Marculescu CE, Berbari EF, Cockerill 3rd FR, et al. Fungi, mycobacteria, zoonotic and other organisms in prosthetic joint infection. Clin Orthop Relat Res 2006; 451: 64–72PubMedCrossRefGoogle Scholar
  72. 72.
    Marculescu CE, Berbari EF, Cockerill 3rd FR, et al. Unusual aerobic and anaerobic bacteria associated with prosthetic joint infections. Clin Orthop Relat Res 2006; 451: 55–63PubMedCrossRefGoogle Scholar
  73. 73.
    Atkins BL, Athanasou N, Deeks JJ, et al. Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty: the OSIRIS Collaborative Study Group. J Clin Microbiol 1998; 36(10): 2932–9PubMedGoogle Scholar
  74. 74.
    Powers KA, Terpenning MS, Voice RA, et al. Prosthetic joint infections in the elderly. Am J Med 1990; 88(5N): 9N–13NPubMedGoogle Scholar
  75. 75.
    Bare J, MacDonald SJ, Bourne RB. Preoperative evaluations in revision total knee arthroplasty. Clin Orthop Relat Res 2006; 446: 40–4PubMedCrossRefGoogle Scholar
  76. 76.
    Teller RE, Christie MJ, Martin W, et al. Sequential indium-labeled leukocyte and bone scans to diagnose prosthetic joint infection. Clin Orthop Relat Res 2000; 373: 241–7PubMedCrossRefGoogle Scholar
  77. 77.
    Trampuz A, Hanssen AD, Osmon DR, et al. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med 2004; 117(8): 556–62PubMedCrossRefGoogle Scholar
  78. 78.
    Cyteval C, Hamm V, Sarrabere MP, et al. Painful infection at the site of hip prosthesis: CT imaging. Radiology 2002; 224(2): 477–83PubMedCrossRefGoogle Scholar
  79. 79.
    Palestro CJ, Swyer AJ, Kim CK, et al. Infected knee prosthesis: diagnosis with In-111 leukocyte, Tc-99m sulfur colloid, and Tc-99m MDP imaging. Radiology 1991; 179(3): 645–8PubMedGoogle Scholar
  80. 80.
    Delank KS, Schmidt M, Michael JW, et al. The implications of 18F-FDG PET for the diagnosis of endoprosthetic loosening and infection in hip and knee arthroplasty: results from a prospective, blinded study. BMC Musculoskelet Disord 2006; 7: 20PubMedCrossRefGoogle Scholar
  81. 81.
    Love C, Marwin SE, Tomas MB, et al. Diagnosing infection in the failed joint replacement: a comparison of coincidence detection 18F-FDG and 111 In-labeled leukocyte/99mTc-sul-fur colloid marrow imaging. J Nucl Med 2004; 45(11): 1864–71PubMedGoogle Scholar
  82. 82.
    Mumme T, Reinartz P, Alfer J, et al. Diagnostic values of positron emission tomography versus triple-phase bone scan in hip arthroplasty loosening. Arch Orthop Trauma Surg 2005; 125(5): 322–9PubMedCrossRefGoogle Scholar
  83. 83.
    Stumpe KD, Notzli HP, Zanetti M, et al. FDG PET for differentiation of infection and aseptic loosening in total hip replacements: comparison with conventional radiography and three-phase bone scintigraphy. Radiology 2004; 231(2): 333–41PubMedCrossRefGoogle Scholar
  84. 84.
    Stumpe KD, Romero J, Ziegler O, et al. The value of FDG-PET in patients with painful total knee arthroplasty. Eur J Nucl Med Mol Imaging 2006; 33(10): 1218–25PubMedCrossRefGoogle Scholar
  85. 85.
    Athanasou NA, Pandey R, de Steiger R, et al. Diagnosis of infection by frozen section during revision arthroplasty. J Bone Joint Surg Br 1995; 77(1): 28–33PubMedGoogle Scholar
  86. 86.
    Chimento GF, Finger S, Barrack RL. Gram stain detection of infection during revision arthroplasty. J Bone Joint Surg Br 1996; 78(5): 838–9PubMedGoogle Scholar
  87. 87.
    Chuard C, Lucet JC, Rohner P, et al. Resistance of Staphylococcus aureus recovered from infected foreign body in vivo to killing by antimicrobials. J Infect Dis 1991; 163(6): 1369–73PubMedCrossRefGoogle Scholar
  88. 88.
    Everts RJ, Chambers ST, Murdoch DR, et al. Successful antimicrobial therapy and implant retention for streptococcal infection of prosthetic joints. ANZ J Surg 2004; 74(4): 210–4PubMedCrossRefGoogle Scholar
  89. 89.
    Marculescu CE, Berbari EF, Hanssen AD, et al. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis 2006; 42(4): 471–8PubMedCrossRefGoogle Scholar
  90. 90.
    Meehan AM, Osmon DR, Duffy MC, et al. Outcome of penicillin-susceptible streptococcal prosthetic joint infection treated with debridement and retention of the prosthesis. Clin Infect Dis 2003; 36(7): 845–9PubMedCrossRefGoogle Scholar
  91. 91.
    Pavoni GL, Giannella M, Falcone M, et al. Conservative medical therapy of prosthetic joint infections: retrospective analysis of an 8-year experience. Clin Microbiol Infect 2004; 10(9): 831–7PubMedCrossRefGoogle Scholar
  92. 92.
    Burger RR, Basch T, Hopson CN. Implant salvage in infected total knee arthroplasty. Clin Orthop Relat Res 1991; 273: 105–12PubMedGoogle Scholar
  93. 93.
    Langlais F. Can we improve the results of revision arthroplasty for infected total hip replacement? J Bone Joint Surg Br 2003; 85(5): 637–40PubMedGoogle Scholar
  94. 94.
    Brandt CM, Sistrunk WW, Duffy MC, et al. Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention. Clin Infect Dis 1997; 24(5): 914–9PubMedCrossRefGoogle Scholar
  95. 95.
    Lieberman JR, Callaway GH, Salvati EA, et al. Treatment of the infected total hip arthroplasty with a two-stage reimplantation protocol. Clin Orthop Relat Res 1994; 301: 205–12PubMedGoogle Scholar
  96. 96.
    Segreti J, Nelson JA, Trenholme GM. Prolonged suppressive antibiotic therapy for infected orthopedic prostheses. Clin Infect Dis 1998; 27(4): 711–3PubMedCrossRefGoogle Scholar
  97. 97.
    Trampuz A, Zimmerli W. Prosthetic joint infections: update in diagnosis and treatment. Swiss Med Wkly 2005; 135(17–18): 243–51PubMedGoogle Scholar
  98. 98.
    Monzon M, Oteiza C, Leiva J, et al. Biofilm testing of Staphylococcus epidermidis clinical isolates: low performance of vancomycin in relation to other antibiotics. Diagn Microbiol Infect Dis 2002; 44(4): 319–24PubMedCrossRefGoogle Scholar
  99. 99.
    Stewart PS. Mechanisms of antibiotic resistance in bacterial biofilms. Int J Med Microbiol 2002; 292(2): 107–13PubMedCrossRefGoogle Scholar
  100. 100.
    Widmer AF, Frei R, Rajacic Z, et al. Correlation between in vivo and in vitro efficacy of antimicrobial agents against foreign body infections. J Infect Dis 1990; 162(1): 96–102PubMedCrossRefGoogle Scholar
  101. 101.
    Widmer AF, Wiestner A, Frei R, et al. Killing of nongrowing and adherent Escherichia coli determines drug efficacy in device-related infections. Antimicrob Agents Chemother 1991; 35(4): 741–6PubMedCrossRefGoogle Scholar
  102. 102.
    Drancourt M, Stein A, Argenson JN, et al. Oral rifampin plus ofloxacin for treatment of Staphylococcus-infected orthopedic implants. Antimicrob Agents Chemother 1993; 37(6): 1214–8PubMedCrossRefGoogle Scholar
  103. 103.
    Konig DP, Schierholz JM, Munnich U, et al. Treatment of staphylococcal implant infection with rifampicin-ciprofloxacin in stable implants. Arch Orthop Trauma Surg 2001; 121(5): 297–9PubMedCrossRefGoogle Scholar
  104. 104.
    Zimmerli W, Widmer AF, Blatter M, et al. Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group. JAMA 1998; 279(19): 1537–41PubMedCrossRefGoogle Scholar
  105. 105.
    Chuard C, Herrmann M, Vaudaux P, et al. Successful therapy of experimental chronic foreign-body infection due to methicillin-resistant Staphylococcus aureus by antimicrobial combinations. Antimicrob Agents Chemother 1991; 35(12): 2611–6PubMedCrossRefGoogle Scholar
  106. 106.
    Lucet JC, Herrmann M, Rohner P, et al. Treatment of experimental foreign body infection caused by methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 1990; 34(12): 2312–7PubMedCrossRefGoogle Scholar
  107. 107.
    Brause BD. Infected total knee replacement: diagnostic, therapeutic, and prophylactic considerations. Orthop Clin North Am 1982; 13(1): 245–9PubMedGoogle Scholar
  108. 108.
    American Cancer Society [online]. Available from URL: [Accessed 2008 Apr 14]
  109. 109.
    Iglehart D, Kaelin C. Diseases of the breast. In: Townsend C, editor. Sabiston textbook of surgery. Philadelphia (PA): Saunders, 2004Google Scholar
  110. 110.
    Alderman AK, Wilkins EG, Kim HM, et al. Complications in postmastectomy breast reconstruction: two-year results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 2002; 109(7): 2265–74PubMedCrossRefGoogle Scholar
  111. 111.
    Armstrong RW, Berkowitz RL, Bolding F. Infection following breast reconstruction. Ann Plast Surg 1989; 23(4): 284–8PubMedCrossRefGoogle Scholar
  112. 112.
    Nahabedian MY, Tsangaris T, Momen B, et al. Infectious complications following breast reconstruction with expanders and implants. Plast Reconstr Surg 2003; 112(2): 467–76PubMedCrossRefGoogle Scholar
  113. 113.
    Lew D, Pittet D, Waldvogel F. Infections that complicate the insertion of prosthetic devices. In: Mayhall C, editor. Hospital epidemiology and infection control. Philadelphia (PA): Lippincott Williams and Wilkins, 2004: 1181–205Google Scholar
  114. 114.
    Vilar-Compte D, Roldan-Marin R, Robles-Vidal C, et al. Surgical site infection (SSI) rates among patients who underwent mastectomy after the introduction of SSI prevention policies. Infect Control Hosp Epidemiol 2006; 27(8): 829–34PubMedCrossRefGoogle Scholar
  115. 115.
    Beatty JD, Robinson GV, Zaia JA, et al. A prospective analysis of nosocomial wound infection after mastectomy. Arch Surg 1983; 118(12): 1421–4PubMedCrossRefGoogle Scholar
  116. 116.
    Cordeiro PG, McCarthy CM. A single surgeon’s 12-year experience with tissue expander/implant breast reconstruction: part I. A prospective analysis of early complications. Plast Reconstr Surg 2006; 118(4): 825–31PubMedCrossRefGoogle Scholar
  117. 117.
    Spear SL, Majidian A. Immediate breast reconstruction in two stages using textured, integrated-valve tissue expanders and breast implants: a retrospective review of 171 consecutive breast reconstructions from 1989 to 1996. Plast Reconstr Surg 1998; 101(1): 53–63PubMedCrossRefGoogle Scholar
  118. 118.
    Holm C, Muhlbauer W. Toxic shock syndrome in plastic surgery patients: case report and review of the literature. Aesthetic Plast Surg 1998; 22(3): 180–4PubMedCrossRefGoogle Scholar
  119. 119.
    Tejirian T, DiFronzo LA, Haigh PI. Antibiotic prophylaxis for preventing wound infection after breast surgery: a systematic review and metaanalysis. J Am Coll Surg 2006; 203(5): 729–34PubMedCrossRefGoogle Scholar
  120. 120.
    Cunningham M, Bunn F, Handscomb K. Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery. Cochrane Database Syst Rev 2006; (2): CD005360Google Scholar
  121. 121.
    Fang A, Hu SS, Endres N, et al. Risk factors for infection after spinal surgery. Spine 2005; 30(12): 1460–5PubMedCrossRefGoogle Scholar
  122. 122.
    Pappou IP, Papadopoulos EC, Sama AA, et al. Postoperative infections in interbody fusion for degenerative spinal disease. Clin Orthop Relat Res 2006; 444: 120–8PubMedCrossRefGoogle Scholar
  123. 123.
    McHenry MC, Easley KA, Locker GA. Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis 2002; 34(10): 1342–50PubMedCrossRefGoogle Scholar
  124. 124.
    Labler L, Keel M, Trentz O, et al. Wound conditioning by vacuum assisted closure (VAC) in postoperative infections after dorsal spine surgery. Eur Spine J 2006; 15(9): 1388–96PubMedCrossRefGoogle Scholar
  125. 125.
    Kowalski TJ, Berbari EF, Huddleston PM, et al. The management and outcome of spinal implant infections: contemporary retrospective cohort study. Clin Infect Dis 2007; 44(7): 913–20PubMedCrossRefGoogle Scholar
  126. 126.
    An HS, Seldomridge JA. Spinal infections: diagnostic tests and imaging studies. Clin Orthop Relat Res 2006; 444: 27–33PubMedCrossRefGoogle Scholar
  127. 127.
    Dumanian GA, Ondra SL, Liu J, et al. Muscle flap salvage of spine wounds with soft tissue defects or infection. Spine 2003; 28(11): 1203–11PubMedGoogle Scholar
  128. 128.
    Kowalski TJ, Berbari EF, Huddleston PM, et al. Do follow-up imaging examinations provide useful prognostic information in patients with spine infection? Clin Infect Dis 2006; 43(2): 172–9PubMedCrossRefGoogle Scholar
  129. 129.
    Cox AM, Malani PN, Wiseman SW, et al. Home intravenous antimicrobial infusion therapy: a viable option in older adults. J Am Geriatr Soc 2007; 55: 645–50PubMedCrossRefGoogle Scholar
  130. 130.
    High KP. Outpatient parenteral antimicrobial therapy: a long overdue option for older adults. J Am Geriatr Soc 2007; 55: 792–3PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Michael H. Young
    • 1
  • Laraine Washer
    • 2
  • Preeti N. Malani
    • 2
    • 3
    • 4
    • 5
  1. 1.Division of Infectious Diseases, Department of Internal MedicineUniversity of Kentucky Medical CenterLexingtonUSA
  2. 2.Division of Infectious Diseases, Department of Internal MedicineUniversity of Michigan Health SystemAnn ArborUSA
  3. 3.Division of Geriatric Medicine, Department of Internal MedicineUniversity of Michigan Health SystemAnn ArborUSA
  4. 4.Veterans Affairs Ann Arbor Healthcare SystemAnn ArborUSA
  5. 5.Geriatric Research Education and Clinical Center (GRECC)Ann ArborUSA

Personalised recommendations