The following set of guidelines represent a collaborative consensus from the orthopaedic, infectious diseases, microbiology, infection control and pharmacy departments at Counties Manukau Health (CMH) for the management of adult patients with suspected Periprosthetic Joint Infections (PJIs).

They are not intended for paediatric patients (please liaise with the relevant department for advice) and contain CMH specific advice.

The guidelines are “living documents” and are therefore subject to ongoing revision. Guidelines should be regularly consulted for the most recent available advice.

Feedback on guidelines is welcome. Please direct any feedback to (infectious diseases physician) or (orthopaedic surgeon).

• Acute Periprosthetic Joint Infections Guideline (PDF, 195.9 KB)
  

  This guideline has been created by the Counties Manukau Periprosthetic Joint Infection Working group and covers the acute management of suspected periprosthetic joint infection (PJI).

• Surgical Strategies in the Management of Periprosthetic Joint Infections Guideline (PDF, 331 KB)
  

  This document has been developed by the Counties Manukau periprosthetic joint infection working group which includes representation from the orthopaedic, infectious diseases, microbiology and infection control departments at Middlemore Hospital. The aim is to provide a framework for surgical decision making to ensure a degree of consistency based on available literature, including the IDSA and Philadelphia consensus guidelines on the management of prosthetic joint infections. The authors acknowledge the complicated nature of this decision and that it is NOT possible to encompass all situations in a guidance document. The authors also acknowledge that decisions will need to be adjusted depending on future events subsequent to the initial surgical strategy decision.

• Periprosthetic Joint Infection Sampling Guideline (PDF, 823 KB)
  

  This guideline aims to provide guidance on standard of care microbiological sampling for suspected prosthetic joint infections.

• Periprosthetic Joint Sample Form (Lab Form) (PDF, 41.5 KB)
  

  This is the laboratory request form that must accompany the culture specimens taken during surgery.

• Periprosthetic Joint Infection Communication Form (PDF, 200.7 KB)
  

  This guideline is designed to facilitate communication between the services regarding the patient specific management strategy

• Elective Arthroplasty Urinary Screening Procedure (PDF, 100.7 KB)
  

  The purpose of this procedure is to identify the necessary steps to take after elective urinary screening.The utility of routine preoperative urinary screening for all patients undergoing elective arthroplasty surgery has been reviewed and is no longer recommended. The new protocol for urinary screening is detailed within.

This guideline addresses the management of adult patients (≥15 years old) presenting to CMDHB with suspected native vertebral osteomyelitis/discitis (NVO). For the purposes of this guideline NVO will relate to vertebral osteomyelitis and/or vertebral discitis. The advice contained is felt to be appropriate for the vast majority of patients presenting with suspected NVO however it does not replace clinical judgement.

This guideline is NOT applicable to the following populations…

1. Post-operative or metal ware associated spinal infections.
2. Spinal infections with a contiguous source (e.g. pressure sore associated spinal infections, post-traumatic spinal infections).
3. Paediatric patients (<15 years old)

• Native Vertebral Osteomyelitis/Discitis Guideline (PDF, 218.4 KB)