What is the management of a leg stump infection likely due to an abrasion from a prosthetic (prosthetic) device?

From the Guidelines

Management of a leg stump infection due to prosthesis abrasion requires prompt treatment with both local wound care and systemic antibiotics, prioritizing the patient's morbidity, mortality, and quality of life. The first step is to clean the wound thoroughly with saline solution and apply an antiseptic such as chlorhexidine or povidone-iodine 1. For mild infections, oral antibiotics like cephalexin (500mg four times daily) or clindamycin (300mg four times daily) for 7-10 days are appropriate, as suggested by the guidelines for managing prosthetic joint infections 1. However, it's crucial to note that the specific antibiotic regimen may vary depending on the causative microorganism, and Table 2 from the guidelines provides a comprehensive list of preferred and alternative treatments for common microorganisms causing prosthetic joint infections 1.

Key Considerations

• Evaluate the patient with a thorough history and physical examination, including tests for sedimentation rate or C-reactive protein (CRP) to aid in diagnosis 1.
• Perform a plain radiograph and consider diagnostic arthrocentesis to confirm the infection and identify the causative organism 1.
• Withhold antimicrobial therapy for at least 2 weeks prior to collecting synovial fluid for culture to increase the likelihood of recovering an organism 1.
• Consider broader coverage with antibiotics such as amoxicillin-clavulanate (875/125mg twice daily) or trimethoprim-sulfamethoxazole (one double-strength tablet twice daily) for moderate to severe infections 1.

Prosthesis Management

• Temporarily discontinue the prosthesis until significant improvement occurs, typically 3-5 days, to prevent further irritation and allow the wound to heal 1.
• Protect the stump with clean, dry dressings changed twice daily during this period.
• Once healing begins, evaluate and modify the prosthesis socket to prevent future abrasions, which may involve padding or liner adjustments to reduce friction 1.

Prevention and Follow-up

• Regular skin inspection is essential to detect early signs of irritation before infection develops.
• Educate the patient on proper wound care and prosthesis management to prevent recurrence.
• Follow-up appointments should be scheduled to monitor the patient's progress and adjust the treatment plan as needed.

From the FDA Drug Label

Skin and Skin Structure Infections: Due to S. aureus (including beta-lactamase-producing strains), S. pyogenes, and other strains of streptococci. When staphylococcal infections are localized and purulent, antibiotics are used as adjuncts to appropriate surgical measures

The management of leg stump infection likely due to abrasion on prosthesis may involve the use of antibiotics such as cefazolin 2 or vancomycin 3 to treat skin and skin structure infections caused by susceptible organisms, including S. aureus and S. pyogenes.

• Surgical measures should be considered as an adjunct to antibiotic therapy for localized and purulent infections.
• Culture and susceptibility studies should be performed to determine the susceptibility of the causative organism to the chosen antibiotic.
• The choice of antibiotic should be based on culture and susceptibility information, or local epidemiology and susceptibility patterns if such data are not available.

From the Research

Management of Leg Stump Infection

• The management of leg stump infection, likely due to abrasion on a prosthesis, involves a multidisciplinary approach, including orthopedic or vascular surgeons, rehabilitation specialists, and infectious diseases physicians 4.
• Obtaining reliable bacteriological documentation, such as abscess aspiration or bone biopsy, is crucial to adapt antibiotic treatment 4.
• Staphylococcus is a common bacterium isolated in stump infections, and the choice of antibiotic depends on the susceptibility of the strain 5, 6, 7.
• For methicillin-susceptible Staphylococcus aureus (MSSA) infections, penicillinase-resistant penicillins, such as flucloxacillin, are the antibiotics of choice, while for methicillin-resistant Staphylococcus aureus (MRSA) infections, parenteral vancomycin or teicoplanin are recommended 5, 6, 7.
• In some cases, surgical revision may be necessary in addition to antibiotic treatment, especially for patients with bone infection 4.
• The use of a 5-day course of combined antibiotics after major lower limb amputation has been shown to reduce wound infection rates and the length of in-hospital stay 8.

Antibiotic Treatment

• The choice of antibiotic depends on the type of infection and the susceptibility of the bacterium 5, 6, 7.
• For less serious MSSA infections, such as skin and soft tissue infections, first-generation cephalosporins, clindamycin, lincomycin, and erythromycin may be used 5.
• For MRSA infections, vancomycin, teicoplanin, or newer antibiotics like linezolid and quinupristin/dalfopristin may be used 5, 6, 7.
• The use of combination therapy, such as rifampicin and fusidic acid, may be necessary for multiresistant MRSA strains 5.