What Is the Optimal Criteria to Use for Detecting Periprosthetic Joint Infections Before Total Joint Arthroplasty?

Background: Total joint arthroplasty (TJA) is one of the most common procedures performed in the United States. Outcomes of this elective procedure may be improved via preoperative optimization of modifiable risk factors. Purposes: We sought to summarize the literature on the clinical implications of preoperative risk factors in TJA and to develop recommendations regarding preoperative optimization of these risk factors. Methods: We searched PubMed in August 2019 with an update in September 2020 for English-language, peer-reviewed publications assessing the influence on outcomes in total hip and knee replacement of 7 preoperative risk factors—obesity, malnutrition, hypoalbuminemia, diabetes, anemia, smoking, and opioid use—and recommendations to mitigate them. Results: Sixty-nine studies were identified, including 3 randomized controlled trials, 8 prospective cohort studies, 42 retrospective studies, 6 systematic reviews, 3 narrative reviews, and 7 consensus guidelines. These studies described worse outcomes associated with these 7 risk factors, including increased rates of in-hospital complications, transfusions, periprosthetic joint infections, revisions, and deaths. Recommendations for strategies to screen and address these risk factors are provided. Conclusions: Risk factors can be optimized, with evidence suggesting the following thresholds prior to surgery: a body mass index <40 kg/m2, serum albumin ≥3.5 g/dL, hemoglobin A1C ≤7.5%, hemoglobin >12.0 g/dL in women and >13.0 g/dL in men, and smoking cessation and ≥50% decrease in opioid use by 4 weeks prior to surgery. Surgery should be delayed until these risk factors are adequately optimized.

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Can nasal Staphylococcus aureus screening and decolonization prior to elective total joint arthroplasty reduce surgical site and prosthesis-related infections? A systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01601-0 ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 5

Author(s):

Xingyang Zhu ◽

Xiaobo Sun ◽

Yuqing Zeng ◽

Wenjun Feng ◽

Jie Li ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Total Joint Arthroplasty ◽

Meta Analysis ◽

Bacterial Species ◽

Surgical Site Infections ◽

Joint Arthroplasty ◽

Cochrane Library ◽

Superficial Infection ◽

Joint Infections ◽

The Impact

Abstract Background Nasal Staphylococcus aureus (S. aureus) screening and decolonization has been widely used to reduce surgical site infections (SSIs) prior to total knee and hip arthroplasty (TKA and THA). However, it remains considerably controversial. The aim of this study was to ascertain whether this scheme could reduce SSIs and periprosthetic joint infections (PJIs) following elective primary total joint arthroplasty (TJA). Methods A systematic search was performed in MEDLINE, Embase, and the Cochrane Library until October, 2019. Outcomes of interest included SSI, PJI, superficial infection, and different bacterial species that caused infections. Data from eligible studies were then extracted and synthesized. Pooled odds ratios (OR) and 95% confidence intervals (CIs) were calculated. We also performed additional analyses to evaluate whether there were differences in postoperative SSIs caused by S. aureus or other bacteria. Results Nine studies were included in our meta-analysis. The pooled data elucidated that nasal S. aureus screening and decolonization dramatically mitigated the risk of SSI, PJI, and superficial infection compared to nondecolonization group. The analysis of bacterial species causing infection also showed that the S. aureus infections postoperative were significantly decreased in the decolonization group. However, there was no statistical difference in the SSI caused by other bacteria between the two groups. Conclusion S. aureus screening and decolonization prior to elective primary THA and TKA could significantly decrease the risk of SSI and PJI. However, more robust studies are needed to further evaluate the impact of S. aureus screening and decolonization on infection risk after TJA.

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Prevalence Of Staphylococcus Aureus Colonization In Patients For Total Joint Arthroplasty In South Africa

10.21203/rs.2.23806/v2 ◽

2020 ◽

Author(s):

Jurek Rafal Tomasz Pietrzak ◽

Zia Maharaj ◽

Lipalo Mokete

Keyword(s):

Risk Factors ◽

South Africa ◽

Staphylococcus Aureus ◽

Total Joint Arthroplasty ◽

Population Group ◽

Developed Countries ◽

Joint Arthroplasty ◽

Joint Infections ◽

Intranasal Mupirocin ◽

Mupirocin Ointment

Abstract Background: Periprosthetic joint infections (PJIs) are a major source of morbidity and mortality for patients undergoing Total Joint Arthroplasty (TJA). Staphylococcus aureus (S aureus) colonization is an independent, modifiable risk factor for periprosthetic joint infections. Post-operative infections are reported to be ten times greater in S aureus carriers than in non-carriers in developed countries though recorded data is lacking for the developing world. This study aims to determine the prevalence of S aureus colonization in patients awaiting TJA in South Africa. Methods: We prospectively assessed 119 patients awaiting Total Knee Arthroplasty and Total Hip Arthroplasty between May and October 2016. We screened three separate anatomical sites on each patient for S aureus. Patients with positive cultures were treated with intranasal mupirocin ointment and chlorhexidine body wash. Univariate and comparative statistical analyses to determine risk factors for colonization was conducted using t-tests, Fisher’s exact tests, and chi square analyses. Results: The overall prevalence of Methicillin Sensitive S aureus colonization was 31.9% (n = 38). There were no patients colonized with Methicillin Resistant S aureus. Nasal swabs returned a yield of 81.6% (n=31), with groin swabs and axillary swabs at 39.5% (n=15) and 28.9% (n=11) respectively. Eradication was successful in 94.74% (n=36) after five days treatment. All patients (100%) were decolonized after counseling and repeat eradication treatment. The overall complication rate was 7.6% (n=9). The 30-day readmission rate in the S aureus -colonized group was 7.9% (n=3) as opposed to 7.4% (n=6) in the non-colonized cohort. There were no 60- and 90-day readmissions and no cases were revised at a mean follow-up of 2.26 years. Conclusions: The rate of S aureus colonization in patients undergoing elective TJA in a developing country was 31.9% and is equivalent to reported rates in developed countries. Eradication treatment with combined intranasal mupirocin ointment and chlorhexidine body wash is a successful treatment modality. A larger cohort of patients is recommended to determine risk factors and post-operative septic sequelae in this population group.

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Sonication in Orthopedics for the Diagnosis of Implant-Associated Infections

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.638.191 ◽

2015 ◽

Vol 638 ◽

pp. 191-196

Author(s):

Catalin Carstoiu ◽

Razvan Ene ◽

Zsombor Panti ◽

Patricia Ene ◽

Raluca Mihailescu ◽

...

Keyword(s):

Total Joint Arthroplasty ◽

Fracture Fixation ◽

Joint Arthroplasty ◽

Etiological Diagnosis ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Sonication Technique ◽

The University ◽

Higher Sensitivity

Introduction. Implant-associated infections in orthopedics represent a major challenge for diagnosis and treatment. Sonication is an alternative method for the diagnosis in prosthetic infections, with a higher sensitivity compared to the conventional periprosthetic cultures. Our aim was to compare the results of conventional culturing and sonication process in per prosthetic joint infections. Material and method. We followed up in a period of 7 years (2007-2014) patients who underwent to total joint arthroplasty, and fracture fixation with internal fixation in the University Emergency Hospital of Bucharest. Conventional and sonication fluid culturing was performed in order to compare the results of it. In 3 cases the cultures after sonication was negative in 9 cases Methicilin resistant (MR) staphylococcus was isolated. Sonication Results Our study involved 34 patients with an average age of 63.08 ±10.65SD. In 3 cases the cultures after sonication was negative in 9 cases Methicilin resistant (MR) staphylococcus was isolated, in 1 case Serratia Marcescens and another case with Staphylococcus Warmei. Discussion Our study underlines the importance of the etiological diagnosis with the application of sonication Coclusions The sonication technique is simple and can be performed in the most of microbiological laboratories. Sonication has the benefit of the etiological diagnosis either in mono-microbial and poli-microbial implant-associated infections, with a higher sensitivity than standard culturing.

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Prevalence Of Staphylococcus Aureus Colonization In Patients For Total Joint Arthroplasty In South Africa

10.21203/rs.2.23806/v1 ◽

2020 ◽

Author(s):

Jurek Rafal Tomasz Pietrzak ◽

Zia Maharaj ◽

Lipalo Mokete

Keyword(s):

Risk Factors ◽

South Africa ◽

Staphylococcus Aureus ◽

Total Joint Arthroplasty ◽

Population Group ◽

Developed Countries ◽

Joint Arthroplasty ◽

Joint Infections ◽

Intranasal Mupirocin ◽

Mupirocin Ointment

Abstract Background: Periprosthetic joint infections are a major source of morbidity and mortality for patients undergoing Total Joint Arthroplasty. Staphylococcus aureus colonization is an independent, modifiable risk factor for periprosthetic joint infections. Post-operative infections are reported to be ten times greater in Staphylococcus aureus carriers than in non-carriers in developed countries though recorded data is lacking for the developing world. This study aims to determine the prevalence of Staphylococcus aureus colonization in patients awaiting Total Joint Arthroplasty in South Africa. Methods: We prospectively assessed 119 patients awaiting Total Knee Arthroplasty and Total Hip Arthroplasty between May and October 2016. We screened three separate anatomical sites on each patient for Staphylococcus aureus. Patients with positive cultures were treated with intranasal mupirocin ointment and chlorhexidine body wash. Univariate and comparative statistical analyses to determine risk factors for colonization was conducted using t-tests, Fisher’s exact tests, and chi square analyses. Results: The overall prevalence of Methicillin Sensitive Staphylococcus aureus colonization was 31.9% (n = 38). There were no patients colonized with Methicillin Resistant Staphylococcus aureus . Nasal swabs returned a yield of 81.6%(n=31), with groin swabs and axillary swabs at 39.5% (n=15) and 28.9% (n=11) respectively. Eradication was successful in 94.74% (n=36) after five days treatment. All patients (100%) were decolonized after counseling and repeat eradication treatment. The overall complication rate was 7.6% (n=9). The 30-day readmission rate in the Staphylococcus aureus -colonized group was 7.9% (n=3) as opposed to 7.4% (n=6) in the non-colonized cohort. There were no 60- and 90-day readmissions and no cases were revised at a mean follow-up of 2.26 years. Conclusions: The rate of Staphylococcus aureus colonization in patients undergoing elective Total Joint Arthroplasty in a developing country was 31.9% and is equivalent to reported rates in developed countries. Eradication treatment with combined intranasal mupirocin ointment and chlorhexidine body wash is a successful treatment modality. A larger cohort of patients is recommended to determine risk factors and post-operative septic sequelae in this population group.

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