is combination systemic therapy superior to monotherapy?
GROUND: The optimal medical or surgical therapy and outcome of enterococcal prosthetic joint infection are unknown. METHOD: We performed a retrospective cohort study involving all patients with enterococcal total hip or knee arthroplasty infection treated at our institution from 1969 through 1999. The outcome for patients treated with combination systemic antimicrobial therapy (a cell wall-active agent and an aminoglycoside) versus monotherapy with a cell wall-active agent was analyzed. RESULTS: Fifty episodes of prosthetic joint infection due to enterococci occurred in 47 patients. The median duration of follow-up was 1253 days (range, 29-4610 days). The median age at the time of diagnosis was 70 years (range, 32-89 years). Fifty percent of episodes (25 of 50 episodes) occurred in male patients; 48% (24 of 50 episodes) involved total hip or knee arthroplasty. The estimate of 2-year survival free of treatment failure was 94% (95% confidence interval [CI], 83%-100%) for patients treated
