Hip Infection

Nervous system An 85-year-old man developed delirium, hallucinations, and generalized myoclonic jerks 7 days after starting to take ciprofloxacin 500 mg bd for a hip infection [24 ]. His symptoms improved with ciprofloxacin withdrawal and oral clonazepam, but recurred on two occasions after reuse of ciprofloxacin. 

Without Vascular Insufficiency Adult (greater 50 years) Postoperative (e.g., hip fractures), soft-tissue infections 5. aureus Nafci 11 i n or cefazolin... 

Hip fracture repair 5. aureus, S. epidermidis Cefazolin 1 gx 1 preoperatively, then every 8 hours for 48 hours Compound fractures are treated as if infection is presumed IA... 

Cefazolin is the best-studied antibiotic and is thus the drug of choice. For hip fracture repairs and joint replacements, it should be administered for 24 hours. Vancomycin is not recommended unless a patient has a history of /3-lactam hypersensitivity or the propensity for MRSA infection at the institution necessitates its use. 

APIC Bioterrorism Task Force and CDC Hospital Infections Program Bioterrorism Working Group. Bioterrorism readiness plan a template for healthcare facilities. Available at http // www.cdc.gov/ncidod/hip/Bio/bio.htm. Accessed October 2001. 

The artificial hip has been used to replace the human hip because the hip is easily worn out over a lifetime of mechanical stress resulting from normal activity. The first artificial hip implant was made by Thermistokles Gluck in 1891 in Berlin. This implant made use of a femoral head of ivory fixed with plaster of paris and glue (Gluck, 1890, 1891). The results were not good due to severe infection problems and adverse foreign body tissue reactions. To develop better hip replacement prosthesis, many materials and procedures were examined between 1925 and 1953. 

In 31 elderly frail women, mean age 86 years, who were randomized to receive growth hormone or placebo for 14 days after surgery for hip fracture, there was an excess of thromboembolic events and chest infections the mechanism was not clear (17). 

Metabolic changes that protease inhibitors can cause after prolonged therapy include raised serum lactate, hypogonadism, hypertension and accelerated cardiovascular disease, reduced bone density, and avascular necrosis of the hip. Two large prospective studies in 1207 patients (972) and 3191 patients (973) have clarified the spectrum and incidence of metabolic changes in HAART and have explored the relative importance of protease inhibitors. In addition, data on fat redistribution from a postmarketing review of HIV-infected individuals taking indinavir have been published (974). 

Clinical outcomes measures can include morbidity and mortality, event rates, and symptom resolution (Ovretveit, 2001). These measures are a direct measure of quality but may be difficult to assess, especially in pharmacy, where their onset could be years following a treatment or intervention (Chassin and Galvin, 1998 Shane and Gouveia, 2000). In these cases, indicators or markers can be used to assess outcomes. These indicators can be condition-specific (e.g., HgAlc) or procedure-specific (e.g., rate of postoperative infection after hip surgery) or address an important issue of patient care. For example, blood pressure may be used as a marker to assess susceptibility to stroke because it is not practical, safe, or ethical to wait and measure the occurrence of stroke. 

Biomaterials are materials foreign to the human body that are used in medicine to replace, support or restore body function. Applications range from central venous and urinary catheters to more complex devices such as prosthetic joints and heart valves. The risk of biomaterial centered infection (BCI) is a key factor limiting their use [1]. The incidence of this type of infections varies for each application for instance 4% for hip prostheses [2] and 10-20% for urinary catheters (see Table 1). In BCI microorganisms are present in close association with the biomaterial surface forming a so-called biofilm. Different species of microorganisms are found in BCI that are often commen-... 

A patient with degenerative joint disease is to undergo insertion of a hip prosthesis. In order to avoid complications due to post-operative infection, the surgeon will pretreat this patient with an antibiotic. This hospital has a significant problem with methicillin-resistant Staphylococcus aureus. Which of the following antibiotics should the surgeon select ... 

Murphy, P. Heal, J.M. Blumberg, N. Infection or suspected infection after hip replacement surgery with autologous or homologous blood transfusions. Transfusion 1991, 31, 312-317. 

In 87 patients with intertrochanteric hip fractures, preoperative antibiotic prophylaxis (gentamicin 240 mg and dicloxacillin 2 g) had no significant effect on wound infections however, there were 16 reversible cases of nephrotoxicity and 1 irreversible case among patients who received antibiotic prophylaxis, compared with only 4 cases of reversible kidney damage among 76 patients who did not receive antibiotics (35). 

Only three of 422 patients treated with a single dose of teicoplanin for antimicrobial prophylaxis during hip or knee arthroplasty (400 mg by intravenous bolus at the time of anesthesia) reported adverse events compared with nine of 424 patients treated with five doses of cefazo-line one had nausea and two had erythema (7). Six patients given teicoplanin had surgical wound infections, and 57 had proven or suspected infections involving other body systems. 

Munakata, K. et ai. (1980) Quamitative struccure-activity relation hip between hy-droxamic acids and their urease inhibitory potency./. Pharmacobiocfyn.. 3,457-462. Bagley. D.H. (1987) Pharmacologic treatment of infection stones. Urol. Clin. North Am.. 14.347-352. 

Trade names Dehydral Haiprex Hip-Rex Hipeksal Hippramine Hiprex (Sanofi-Aventis) Mandelamine Prosed Reflux Urasal Urised Uroqid Urotractan Indications Urinary tract infections Category Antibiotic Half-life 3-6 hours... 

A separate polyanhydride system has also been investigated for the treatment of osteomyelitis, a bone infection typically caused by bacteria. ° Copolymer implants (50 50 FAD SA) containing gentamicin were tested in the backs of rats, in the infected tarso-crural joints of horses, and in humans with infected prosthetic hips or knees. In all the cases, the local delivery of gentamicin was successful and the systemic exposure to the drug was avoided. 

Nongonococcal bacterial arthritis almost always involves only a single joint. The knee is the most commonly involved joint, but infections also may occur in the shoulder, wrist, hip, ankle, interpha-langeal joints, and elbow joints. Usually, the initial focus of infection that acted as the source for bacterial or microbial entrance can be identified. Common routes for bacterial entrance include infections of the respiratory tract, skin, and urinary tract. Blood cultures are important in these patients because they may be positive in 50% of patients. 

Summary A 15-year-old African-American female with recurrent bilateral thigh and hip pain, anemia, and symptoms and laboratory evidence of a urinary tract infection. 

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