The use of custom-made antibiotic-loaded spacer in periprosthetic knee infection caused by XDR organism: case report and review of literature

G. Noia, M.C. Meluzio, G. Sircana, G. Maccauro, M. Fantoni, A. Ziranu

Department of Aging, Orthopedics and Rehabilitation; Institute of Orthopedics, Traumatology and Spine Surgery, Fondazione Policlinico Agostino Gemelli – IRCCS, Università Cattolica del Sacro Cuore di Roma, Rome, Italy

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• Infectious Diseases
• Orthopedics

Periprosthetic knee infection (PKI) remains one of the most challenging complications after total knee replacement, especially if caused by multidrug-resistant (MDR) or extensively drug-resistant (XDR) organisms. Multiple treatment options are available, such as long-term antibiotic suppression, surgical debridement with retention of the prosthesis, definitive resection arthroplasty, arthrodesis, one-stage or two-stage revision procedures, amputation.
We present a rare case of a PKI caused by a XDR Klebsiella pneumoniae in a young patient who underwent a prosthetic reconstruction due to an osteosarcoma of the tibia. In this patient, the PKI has been treated using intravenous administration of Amikacin and an Amikacin-impregnated PMMA custom-made spacer.
To our knowledge, only two cases that successfully used hand-mixed antibiotic-loaded spacer based on antibiotic sensitivity for the treatment of PKI caused by MDR and XDR microorganisms have been reported in the literature.

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