Evaluation of Outpatient Parenteral Teicoplanin Treatment Results in Staphylococcal Orthopedic Prosthesis Infections

Introduction: Today, orthopedic prostheses are being increasingly utilized in people with degenerative joint disease. In these patients, the aim is to increase the quality of life. However, associated infections, most commonly caused by staphylococci, sometimes result in a decrease in the quality of life. Therefore, we aimed to investigate the results of outpatient parenteral teicoplanin treatment. Patients and Methods: Fourteen patients between January 2006 and December 2007 retrospectively and 18 patients between January and December 2008 prospectively were included. Possible prosthesis infection was diagnosed by erythema, swelling, temperature increase in the operation area, and elevation of erythrocyte sedimentation rate and C-reactive protein levels. Teicoplanin (1 x 800 mg/day) was given to patients in whom methicillin-resistant staphylococci were isolated in at least two microbiological cultures taken during the prosthesis removal or in aspiration culture. Patients were followed up weekly. Results: Totally, 32 joint prosthesis patients infected with staphylococci were followed. Methicillin-resistant coagulase-negative staphylococci (75%) were the most common strain (24 patients), followed by methicillin-resistant Staphylococcus aureus (15.6%) (5 patients). Methicillin-susceptible coagulase-negative staphylococci were diagnosed in 2 (6.3%) patients and methicillin-susceptible S. aureus (3.1%) in 1 patient. The difference between mean C-reactive protein values before and after treatment was found to be significant (p= 0.000). Surgical debridement and teicoplanin treatment was successful in 87.5% of the cases; without surgical debridement, the treatment success rate was 71.9%. The cost of therapy for patients treated with outpatient teicoplanin therapy regimen was found lower than for the others treated with hospitalization. Conclusion: C-reactive protein remains the most valuable marker in the prosthesis infection diagnosis and follow-up. As we observed no side effects and the treatment success was high and effective, outpatient parenteral teicoplanin treatment can be an appropriate choice for joint prosthesis infections