Microbiologic epidemiology depending on time to occurrence of prosthetic joint infection: a prospective cohort study

ABSTRACTThe empirical use of vancomycin in combination with a broad-spectrum beta-lactam is currently recommended after the initial surgery of prosthetic joint infection (PJI). However, the tolerability of such high-dose intravenous regimens is poorly known. Adult patients receiving an empirical antimicrobial therapy (EAT) for a PJI were enrolled in a prospective cohort study (2011 to 2016). EAT-related adverse events (AE) were described according to the common terminology criteria for AE (CTCAE), and their determinants were assessed by logistic regression and Kaplan-Meier curve analysis. The EAT of the 333 included patients (median age, 69.8 years; interquartile range [IQR], 59.3 to 79.1 years) mostly relies on vancomycin (n= 229, 68.8%), piperacillin-tazobactam (n= 131, 39.3%), and/or third-generation cephalosporins (n= 50, 15%). Forty-two patients (12.6%) experienced an EAT-related AE. Ten (20.4%) AE were severe (CTCAE grade ≥ 3). The use of vancomycin (odds ratio [OR], 6.9; 95% confidence interval [95%CI], 2.1 to 22.9), piperacillin-tazobactam (OR, 3.7; 95%CI, 1.8 to 7.2), or the combination of both (OR, 4.1; 95%CI, 2.1 to 8.2) were the only AE predictors. Acute kidney injury (AKI) was the most common AE (n= 25; 51.0% of AE) and was also associated with the use of the vancomycin and piperacillin-tazobactam combination (OR, 6.7; 95%CI, 2.6 to 17.3). A vancomycin plasma overexposure was noted in nine (37.5%) of the vancomycin-related AKIs only. Other vancomycin-based therapies were significantly less at risk for AE and AKI. The EAT of PJI is associated with an important rate of AE, linked with the use of the vancomycin and the piperacillin-tazobactam combination. These results corroborate recent findings suggesting a synergic toxicity of these drugs in comparison to vancomycin-cefepime, which remains to be evaluated in PJI. (This study has been registered at ClinicalTrials.gov under identifier NCT03010293.)

Download Full-text

Proton-pump inhibitors are associated with increased risk of prosthetic joint infection in patients with total hip arthroplasty: a case-cohort study

Acta Orthopaedica ◽

10.1080/17453674.2021.1920687 ◽

2021 ◽

pp. 1-5

Author(s):

Maarten M Bruin ◽

Ruud L M Deijkers ◽

Roos Bazuin ◽

Erika P M Elzakker ◽

Bart G Pijls

Keyword(s):

Cohort Study ◽

Total Hip Arthroplasty ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Hip Arthroplasty ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Total Hip ◽

Prosthetic Joint ◽

Increased Risk

Download Full-text

Biofilm-active antibiotic treatment improves the outcome of knee periprosthetic joint infection: Results from a 6-year prospective cohort study

International Journal of Antimicrobial Agents ◽

10.1016/j.ijantimicag.2020.105904 ◽

2020 ◽

Vol 55 (4) ◽

pp. 105904 ◽

Cited By ~ 2

Author(s):

Max Gellert ◽

Sebastian Hardt ◽

Karolin Köder ◽

Nora Renz ◽

Carsten Perka ◽

...

Keyword(s):

Cohort Study ◽

Antibiotic Treatment ◽

Prospective Cohort Study ◽

Periprosthetic Joint Infection ◽

Prospective Cohort ◽

Joint Infection

Download Full-text

Risk of Recurrent Staphylococcus aureus Prosthetic Joint Infection in Rheumatoid Arthritis Patients—A Nationwide Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz451 ◽

2019 ◽

Vol 6 (11) ◽

Author(s):

Namrata Singh ◽

Rajeshwari Nair ◽

Michihiko Goto ◽

Martha L Carvour ◽

Ryan Carnahan ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Staphylococcus Aureus ◽

Cohort Study ◽

Prosthetic Joint Infection ◽

Proportional Hazards ◽

Joint Infection ◽

International Classification Of Diseases ◽

Cox Proportional Hazards ◽

Prosthetic Joint ◽

Implant Retention

AbstractBackgroundTreatment of rheumatoid arthritis (RA) often involves immune-suppressive therapies. Concern for recurrent prosthetic joint infection (PJI) in RA patients might be high and could reduce use of joint implantation in these patients. We aimed to evaluate the risk of recurrence of PJI in RA patients compared with osteoarthritis (OA) patients by utilizing a large health care system.MethodsWe conducted a retrospective cohort study of all patients admitted for a Staphylococcus aureus PJI who underwent debridement, antibiotics, and implant retention (DAIR) or 2-stage exchange (2SE) between 2003 and 2010 at 86 Veterans Affairs Medical Centers. Both RA patients and the comparison group of osteoarthritis (OA) patients were identified using International Classification of Diseases, Ninth Revision, codes. All index PJI and recurrent positive cultures for S. aureus during 2 years of follow-up were validated by manual chart review. A Cox proportional hazards regression model was used to compare the time to recurrent PJI for RA vs OA.ResultsIn our final cohort of 374 veterans who had either DAIR or 2SE surgery for their index S. aureus PJI, 11.2% had RA (n = 42). The majority of the cohort was male (97.3%), and 223 (59.6%) had a methicillin-susceptible S. aureus PJI. RA patients had a similar risk of failure compared with OA patients, after adjusting for covariates (hazard ratio, 0.81; 95% confidence interval, 0.48–1.37).ConclusionsPrior diagnosis of RA does not increase the risk of recurrent S. aureus PJI. Further studies are needed to evaluate the effect of different RA therapies on outcomes of episodes of PJI.

Download Full-text

Prosthetic joint infection following hip fracture and degenerative hip disorder: a cohort study of three thousand, eight hundred and seven consecutive hip arthroplasties with a minimum follow-up of five years

International Orthopaedics ◽

10.1007/s00264-015-2989-y ◽

2015 ◽

Vol 39 (11) ◽

pp. 2091-2096 ◽

Cited By ~ 17

Author(s):

Richard Blomfeldt ◽

Piotr Kasina ◽

Carin Ottosson ◽

Anders Enocson ◽

Lasse J. Lapidus

Keyword(s):

Cohort Study ◽

Hip Fracture ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Prosthetic Joint ◽

Hip Arthroplasties

Download Full-text

THU0072 Risk of revision, prosthetic joint infection and death following total hip or knee arthroplasty in patients with rheumatoid arthritis – a nationwide cohort study from denmark

10.1136/annrheumdis-2017-eular.1742 ◽

2017 ◽

Author(s):

RL Cordtz ◽

LE Kristensen ◽

S Overgaard ◽

A Odgaard ◽

H Lindegaard ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Knee Arthroplasty ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Total Hip ◽

Prosthetic Joint

Download Full-text

Surgical Site Infection After Primary Hip and Knee Arthroplasty: A Cohort Study Using a Hospital Database

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.148 ◽

2015 ◽

Vol 36 (10) ◽

pp. 1198-1207 ◽

Cited By ~ 25

Author(s):

Leslie Grammatico-Guillon ◽

Sabine Baron ◽

Philippe Rosset ◽

Christophe Gaborit ◽

Louis Bernard ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Knee Arthroplasty ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Public Hospitals ◽

Prosthetic Material ◽

Hospital Database ◽

Prosthetic Joint

BACKGROUNDHip or knee arthroplasty infection (HKAI) leads to heavy medical consequences even if rare.OBJECTIVETo assess the routine use of a hospital discharge detection algorithm of prosthetic joint infection as a novel additional tool for surveillance.METHODSA historic 5-year cohort study was built using a hospital database of people undergoing a first hip or knee arthroplasty in 1 French region (2.5 million inhabitants, 39 private and public hospitals): 32,678 patients with arthroplasty code plus corresponding prosthetic material code were tagged. HKAI occurrence was then tracked in the follow-up on the basis of a previously validated algorithm using International Statistical Classification of Disease, Tenth Revision, codes as well as the surgical procedures coded. HKAI density incidence was estimated during the follow-up (up to 4 years after surgery); risk factors were analyzed using Cox regression.RESULTSA total of 604 HKAI patients were identified: 1-year HKAI incidence was1.31%, and density incidence was 2.2/100 person-years in hip and 2.5/100 person-years in knee. HKAI occurred within the first 30 days after surgery for 30% but more than 1 year after replacement for 29%. Patients aged 75 years or older, male, or having liver diseases, alcohol abuse, or ulcer sore had higher risk of infection. The inpatient case fatality in HKAI patients was 11.4%.CONCLUSIONSThe hospital database method used to measure occurrence and risk factors of prosthetic joint infection helped to survey HKAI and could optimize healthcare delivery.Infect Control Hosp Epidemiol 2015;36(10):1198–1207

Download Full-text

Incidence and predictors of prosthetic joint infection following primary total knee arthroplasty: A 15-year population-based cohort study

The Journal of Arthroplasty ◽

10.1016/j.arth.2021.10.006 ◽

2021 ◽

Author(s):

Anthony Bozzo ◽

Seper Ekhtiari ◽

Kim Madden ◽

Mohit Bhandari ◽

Michelle Ghert ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Cohort Study ◽

Knee Arthroplasty ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Primary Total Knee Arthroplasty ◽

Population Based ◽

Prosthetic Joint ◽

Total Knee ◽

Primary Total Knee

Download Full-text

Non-elective and revision arthroplasty are independently associated with hip and knee prosthetic joint infection caused by Acinetobacter baumannii: a Brazilian single center observational cohort study of 98 patients

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04393-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Raquel Bandeira da Silva ◽

Rodrigo Otavio Araujo ◽

Mauro José Salles

Keyword(s):

Cohort Study ◽

Treatment Failure ◽

Acinetobacter Baumannii ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Rank Test ◽

Chronic Infections ◽

Link Type ◽

Prosthetic Joint

Abstract Background Prosthetic joint infection (PJI) caused by Acinetobacter baumannii (Ab) has become a growing concern due to its overwhelming ability to express resistance to antibiotics and produce biofilm. Aim This study aimed to identify independent risk factors (RFs) associated with Ab-associated PJI and their role in the treatment outcome. Methods This was a single-centre, retrospective cohort study of PJI patients diagnosed between January 2014 and July 2018. A PJI diagnosis was made based upon the MSIS 2018 criteria. To estimate RFs associated with Ab-associated PJI, multivariate analyses with a level of significance of p < 0.05 were performed. To evaluate treatment failure, Kaplan–Meier analysis and log-rank test were performed. Results Overall, 98 PJI cases were assessed, including 33 with Ab-associated PJI and 65 with PJI involving other microorganisms (non–Ab-associated PJI). Independent RFs associated with Ab-associated PJI were revision arthroplasty [odds ratio (OR) = 3.01; 95% confidence interval (CI) = 1.15–7.90; p = 0.025] and nonelective arthroplasty (OR = 2.65; 95% CI = 1.01–7.01; p = 0.049). Ab-associated PJI was also more likely than non–Ab-associated PJI to be classified as a chronic late infection (OR = 5.81; 95% CI = 2.1–16.07; p = 0.001). Ab-associated PJI was not associated with treatment failure (p = 0.557). Conclusions Late chronic infections, surgical revision and nonelective arthroplasty are well-known predictors of PJI but were also independently associated with Ab-associated PJI. Infections caused by Ab and surgical treatment with debridement, antibiotics and implant retention were not associated with PJI treatment failure. Trial registration Study data supporting our results were registered with the Brazilian Registry of Clinical Trials (https://www.ensaiosclinicos.gov.br/rg/RBR-6ft5yb/), an open-access virtual platform for the registration of studies on humans performed in Brazil. Registration no.RBR-6ft5yb.

Download Full-text