Fig. 3
Surgical strategy in relation to antibiotic treatment duration.
1A 2-stage exchange without antibiotic holiday is preferred. 2Targeted antibiotics in spacer (incl. vancomycin regardless of causative agent). If the causative agent is unknown, the most commonly used regimen is: gentamicin and vancomycin. Prefabricated spacers often contain gentamicin and clindamycin in the cement, but previous studies have shown that adding vancomycin (2 g per 40 g of cement) reduces secondary spacer infections with coagulase-negative Staphylococci [10], and is therefore recommended to be added. In general, it should be taken into account that the stability of the cement is adversely affected if more than 10% antibiotics are added to the cement (= 4 g of antibiotics per 40 g of cement). This is especially important with cement fixation (and less so when using temporary cement spacers). 3Provided that reimplantation cultures are negative