Regardless of local or systemic therapies used in conjunction with implant removal, bacterial culture and susceptibility testing is recommended following implant removal. While a positive culture may not indicate the need for antimicrobial treatment, it allows for proper selection of the antimicrobial if treatment is determined to be clinically indicated. A positive culture result has been reported following implant removal in 72–80% of cases [18, 23]. However, sonication of implants may aid in improved bacterial recovery when considering culture and susceptibility testing [33]. As sonication is not likely to be performed routinely for culture and susceptibility testing, this may play a role in identification of negative culture results following implant removal for SSI. Alternatively, preoperative treatment with antimicrobial therapy targeted at the known microorganisms may be sufficient to eradicate or significantly reduce the microbial burden, such that a negative culture result is achieved post implant removal [13, 18, 23].
3.4 Follow‐Up
Following diagnosis of an SSI, continued frequent communication is necessary to ensure response to therapy. If empirical therapy is instituted without improvement of clinical signs, bacterial culture and susceptibility testing is recommended to guide therapy, if this is not already under way. Duration of antimicrobial therapy is controversial but should reflect the level of the infection, such that a superficial SSI receives a shorter course of antimicrobial therapy than a deep or organ/space SSI. At any time that antimicrobial therapy has been discontinued and clinical signs of SSI recur, implant removal should be considered to remove the largest burden of disease associated with a likely biofilm‐associated implant infection. Following discontinuation of antimicrobial therapy or implant removal, active surveillance protocols to acquire follow‐up information regarding resolution or recurrence of clinical signs should be implemented. Setting in place an infection control plan in your hospital to determine annual SSI rates in general, but specifically associated with surgically implanted devices, will be beneficial to document and monitor trends, thus allowing earlier interventions when SSI rates are increasing.
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