Table 2. Patient data
Patient number / Age/sex / Joint / Antibiotic spacer type / Cement quantity and antibiotic concentration / Preimplantation prosthetic joint aspirate culture / Prosthetic joint aspirate cell count & differential / Reimplantation periprosthetic tissue culture / Reimplantationsonication fluid culture / Postreimplanta-tion prosthetic joint aspirate culture / Re-opera-tion / Sup-pres-sion / Death / Re-infec-tion / Time to reinfec-tion / MSIS criteria for diagnosis of reinfection
1 / 68/M / Knee / Biomet® articulating spacer / 3 packs ,
3 g vancomycin,
10.8 g tobramycin / Staphylococcus species not S aureus / Data not available / Staphylococcus species not S aureus / 20 CFU/mL / Negative / No / No / No / No / N/A / N/A
2 / 58/M / Knee / Biomet® articulating spacer / 3 packs ,
3 g vancomycin,
10.8 g tobramycin / Negative / 29,000/
90% / Negative / 20 CFU/mL, Gram positive cocci / Enterococcus species / Yes / No / No / Yes / 4 weeks / ÝESR & CRP, + Cx, ÝWBC cell count (19,050), Ý% PMNs (95%)
3 / 79/F / Knee / Biomet® articulating spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / Pseudomonas aeruginosa, Staphylococcus species not S aureus / Data not available / Negative / Negative / Negative / No / No / No / No / N/A / N/A
4 / 57/M / Knee / Biomet® articulating spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / Staphylococcus species not S aureus / 2760/3% / Negative / 20 CFU/mL, Clostridium clostridiform / Negative / No / No / No / No / N/A / N/A
5 / 75/M / Knee / Biomet® articulating spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / Staphylococcus species not S aureus / 35,000/
95% / Staphylococcus species not S aureus / > 100 CFU/mL, Staphylococcus species not S aureus / MRSA / Yes / No / No / Yes / 5 months / ÝESR & CRP, + Cx, ÝWBC cell count (2250)*
6 / 82/F / Knee / Biomet® articulating spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / MSSA / Data not available / Negative / Negative / Negative / No / No / Yes / No / N/A / N/A
7 / 65/F / Knee / Biomet® articulating spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / Staphylococcus species not S aureus / Data not available / Negative / 20 CFU/mL / N/A / No / No / No / No / N/A / N/A
8 / 67/M / Hip / Prostalac® hip spacer / 4 packs , 4 g vancomycin, 13.8 g tobramycin / MRSA / 2860/95% / Negative / Negative / N/A / No / No / No / No / N/A / N/A
9 / 84/F / Knee / Static spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / MSSA / 332,300/
89% / Negative / Negative / N/A / No / No / No / No / N/A / N/A
10 / 45/F / Knee / Biomet® articulating spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / MSSA / 20,333/
91% / MSSA / 20 CFU/mL / N/A / Yes / Yes / No / Yes / 3 months / +Cx, ÝESR & CRP, + surgical pathology, ÝWBC cell count, Ý% PMNs
11 / 82/M / Knee / Biomet® articulating spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / Negative / Data not available / Negative / 20 CFU/mL / N/A / No / No / Yes / No / N/A / N/A
12 / 53/M / Knee / Biomet® articulating spacer / 4 packs,
6 g cefazolin/pack / MSSA / 69,000/
93% / MSSA / > 100 CFU/mL, MSSA / N/A / Yes / Yes / No / Yes / 3 months / +Cx, ÝESR & CRP, + surgical pathology, ÝWBC cell count, Ý% PMNs
13 / 60/M / Knee / Biomet® articulating spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / Negative / Data not available / Negative / Negative / N/A / No / No / No / No / N/A / N/A
14 / 69/M / Knee / Biomet® articulating spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / Enterobacter cloacae / 27,700/
98% / Negative / Negative / N/A / No / No / No / No / N/A / N/A
15 / 64/F / Knee / Biomet® articulating spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / Negative / 2241/44% / Negative / Negative / Negative / No / No / No / No / N/A / N/A
16 / 20/M / Knee / Biomet® articulating spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / Negative / 2000/94% / Negative / Negative / MSSA / Yes / No / No / Yes / 4 weeks / ÝESR & CRP, purulence, + Cx, ÝWBC cell count, Ý% PMNs
17 / 56/M / Knee / Biomet® articulating spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / Negative / 1568/49% / Negative / Negative / Negative / No / No / No / No / N/A / N/A
18 / 65/M / Knee / Biomet® articulating spacer / 3 packs,
4 g cefazolin,
2.4 g tobramycin/
pack / Negative / 362,000/
89% / Negative / > 100 CFU/mL, Escherichia coli / Staphylococcus species not S aureus / Yes / Yes / Yes / Yes / 2 weeks / ST, + Cx, ÝESR & CRP
19 / 81/M / Knee / Biomet® articulating spacer / 3 packs,
6 g vancomycin,
2.4 g tobramycin/
pack / Negative / 38,000/
97% / Staphylococcus species not S aureus / Negative / N/A / No / No / Yes / No / N/A / N/A
20 / 70/F / Knee / Static spacer / 3 packs, 6.7 g vancomycin/pack / MSSA / 60,500/
99% / Negative / Negative / N/A / No / No / No / No / N/A / N/A
21 / 70/F / Knee / Biomet® articulating spacer / 3 packs, 6 g vancomycin/pack / Streptococcus viridans group / Data not available / Negative / Negative / N/A / No / No / No / No / N/A / N/A
22 / 71/F / Knee / Biomet® articulating spacer / 2 packs, 4 g vancomycin, 2.4 g tobramycin/pack / Staphylococcus species not S aureus / 15,500/
99% / Negative / Negative / N/A / No / No / No / No / N/A / N/A
23 / 78/F / Knee / Biomet® articulating spacer / 2 packs, 5 g vancomycin, 2.4 g tobramycin/pack / Negative / 55,100/
92% / Negative / 20 CFU/mL / Negative / No / No / No / No / N/A / N/A
24 / 59/F / Knee / Biomet® articulating spacer / 3 packs, 4 g vancomycin, 2.4 g tobramycin/pack / MSSA / 32,113/
97% / Negative / Negative / N/A / No / No / No / No / N/A / N/A
25 / 76/F / Knee / Static spacer / Data not available / Negative / Data not available / MSSA / Negative / N/A / No / No / No / No / N/A / N/A
26 / 64/F / Knee / Biomet® articulating spacer / 4 packs, 2.5 g vancomycin, 3 g tobramycin/pack / MRSA / 214,000/
7% / Negative / Negative / N/A / No / No / No / No / N/A / N/A
27 / 62/F / Knee / Static spacer / 4 packs, 5 g vancomycin/pack / Negative / 15,300/
93% / Negative / 20 CFU/mL / N/A / No / No / No / No / N/A / N/A
28 / 59/M / Knee / Static spacer / 3 packs, 6 g vancomycin, 2.4 g tobramycin/pack / MSSA / 75,300/
95% / Negative / 20-50 CFU/mL, MSSA / Negative / Yes / Yes / No / Yes / 1 week / ST, ÝESR & CRP
29 / 64/F / Knee / Biomet® articulating spacer / Data not available / Negative / 45,500/
96% / Negative / > 100 CFU/mL, Escherichia coli / N/A / No / No / No / No / N/A / N/A
30 / 73/M / Knee / Static spacer / 3 packs, 4 g vancomycin/pack / MRNSA / 24,400/
99% / Negative / Negative / Corynebacterium / Yes / Yes / No / Yes / 27 months / + Cx, ÝWBC cell count (10,750), Ý% PMNs (99%),
31 / 64/M / Hip / Static spacer / 3 packs ,
3 g vancomycin ,
10.8 g tobramycin / MRSA / Data not available / MRSA / > 100 CFU/mL Bacteroides species, 50 - 100 CFU/mL Candida species, < 20 CFU/mL MRSA / Escherichia coli, Pseudomonas species / Yes / Yes / No / Yes / 4 weeks / ST, ÝESR & CRP, + Cx, purulence
32 / 86/F / Hip / Prostalac® hip spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / Escherichia coli / Data not available / Negative / Negative / N/A / Yes** / No / No / No / N/A / N/A
33 / 84/M / Hip / Prostalac® hip spacer / 4 packs, 6 g vancomycin/pack / MSSA / Data not available / Negative / 100 CFU/mL, MSSA / N/A / No / No / No / No / N/A / N/A
34 / 76/F / Hip / Prostalac® hip spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / Streptococcus viridans group / 15,400/
95% / Negative / 20 CFU/mL, Enterococcus species / N/A / No / No / No / No / N/A / N/A
35 / 72/M / Hip / Prostalac® hip spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / MRSA & MSSA / Data not available / Negative / > 100 CFU/mL MSSA, 50 - 100 CFU/mL MRSA / Negative / Yes / Yes / No / Yes / 3 weeks / ST, + Cx, purulence
36 / 84/M / Hip / Prostalac® hip spacer / 3 packs,
3 g vancomycin,
10.8 g tobramycin / MRSA / 115,000/
97% / MRSA / 100 CFU/mL, MRSA / MRSA / Yes / Yes / No / Yes / 4 months / ÝESR & CRP, + Cx, purulence, ÝWBC cell count (6438), Ý% PMNs (94%)
Biomet® articulating spacer, Biomet Inc, Warsaw, IN, USA; Prostalac® hip spacer, DePuy, Inc, Warsaw, IN, USA; *aspiration grossly bloody, fluid clotted, cell count questionable (WBC count = 2250, cell differential data not available). Patient judged to have persistent clinical infection; ** unrelated hip reoperation for a dislocation, no infection; MSIS = Musculoskeletal Infection Society; MSSA = methicillin-sensitive Staphylococcus aureus; MRSA = methicillin-resistant Staphylococcus aureus; MRNSA = methicillin-resistant non-Staphylococcus aureus; CFU = colony forming units; N/A = not applicable; ST = positive sinus tract; + surgical pathology = acute inflammation > 5 WBC/high power field; ÝESR = elevated erythrocyte sedimentation rate (> 30 mm/hour), CRP = C-reactive protein (> 10 mg/L), ÝWBC cell count (# ) = elevated synovial fluid WBC count > 3000 (number in parentheses), Ý% PMN = polymorphonuclear leukocytes (%) = greater than 80% (percentage in parentheses); + Cx = one positive microbiologic culture subsequent to reimplantation; + Cx X 2 = 2 positive microbiologic cultures after reimplantation with the same organism; purulence = gross purulence seen during surgery or synovial fluid sampling subsequent to reimplantation.