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Background/Aim. Infection following total hip arthroplasty (THA) or total   knee arthoplasty (TKA) may have devastating consequences. Some bacterial   strains are often encountered as agents of these infections, others occur   less frequently but are sometimes burdened with more severe complications.   Klebsiella spp. are uncommon causes of THA or TKA infection. The aim of this   study was to identify an effective treatment algorithm for multidrug   resistant Klebsiella spp. caused THA or TKA infections. Methods. During the   3-year period, from January 1 2009 to December 31 2011, we registered and   treated 5 patients with THA or TKA multidrug resistant Klebsiella spp. caused   infection. All the patients were primarily operated in other institutions,   and were admitted in our clinic after the onset of infection symptoms. In   three of the cases Klebsiella infection was complicated by additional   infection (Staphyloccocus aureus, Pseudomonas aeruginosa and Serratia   marscescens). In 3 of the cases we performed revision arthroplasty after   double exchange of antibiotic-loaded articulating cement spacer, and in 2 of   the cases the standard two stage revision approach with one antibiotic cement   spacer exchange was applied. Results. The mean length of follow-up after   reimplantation surgery was 17.1 months (range 2-31 months). One patient died   2 months after the final reimplantation procedure. The initial Klebsiella   infection was eradicated in all patients. At the end follow-up after   definitive reimplantation, patients had no clinical, laboratory or   microbiological parameters positive for active infection. Conclusion.   According to our experience with multidrug-resistant Klebsiella TKA/THA   infections, two-stage approach, in some cases with double articulating cement   spacer exchange prior to definitive reimplantation, is the most effective   treatment option

Antibiotic-loaded cement spacer for treatment of Klebsiella infected total hip and knee arthroplasty