Is preoperative screening for meticillin-susceptible Staphylococcus aureus in joint replacement surgery cost-effective to reduce surgical site infections?

Abstract Background The risk for developing a periprosthetic joint infection (PJI) during bacteremia is unclear, except for Staphylococcus aureus bacteremia. The aim of this study was to examine the risk for developing a PJI during bacteremia and to identify possible risk factors leading to it. Methods Patients with a primary knee or hip joint replacement performed in a tertiary care hospital between September 2002 and December 2013 were identified (n = 14 378) and followed up until December 2014. Positive blood culture results during the study period and PJIs were recorded. PJIs associated with an episode of bacteremia were identified and confirmed from patient records. Potential risk factors for PJI among those with bacteremia were examined using univariate logistic regression. Results A total of 542 (3.8%) patients had at least 1 episode of bacteremia. Seven percent (47/643) of the bacteremias resulted in a PJI. Development of a PJI was most common for Staphylococcus aureus (21% of bacteremias led to a PJI) and beta-hemolytic streptococci (21%), whereas it was rare for gram-negative bacteria (1.3%). Having ≥2 bacteremias during the study period increased the risk for developing a PJI (odds ratio, 2.29; 95% confidence interval, 1.17–4.50). The risk for developing a PJI was highest for bacteremias occurring within a year of previous surgery. Chronic comorbidities did not affect the risk for PJI during bacteremia. Conclusions The development of a PJI during bacteremia depends on the pathogen causing the bacteremia and the timing of bacteremia with respect to previous joint replacement surgery. However, significant patient-related risk factors for PJI during bacteremia could not be found.

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Joint Replacement Surgery Booklet

Internal Medicine News ◽

10.1016/s1097-8690(07)71505-6 ◽

2008 ◽

Vol 41 (1) ◽

pp. 17

Keyword(s):

Joint Replacement ◽

Joint Replacement Surgery ◽

Replacement Surgery

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Would Allowing Privately Funded Health Care Reduce the Public Waiting Time? Theory and Empirical Evidence from Canadian Joint Replacement Surgery Data

SSRN Electronic Journal ◽

10.2139/ssrn.2154134 ◽

2012 ◽

Author(s):

Hong Chen ◽

Qu Qian ◽

Anming Zhang

Keyword(s):

Health Care ◽

Empirical Evidence ◽

Waiting Time ◽

Joint Replacement ◽

The Public ◽

Joint Replacement Surgery ◽

Replacement Surgery ◽

Time Theory

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COVID-19 (SARS-CoV-2) lymphocyte responses are associated with inflammatory biomarkers in total joint replacement surgery candidates pre-operatively

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02563-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Marco S. Caicedo ◽

Vianey Flores ◽

Alicia Padilla ◽

Samelko Lauryn ◽

Joshua J. Jacobs ◽

...

Keyword(s):

Joint Replacement ◽

Total Joint Replacement ◽

Cross Reactivity ◽

Inflammatory Biomarkers ◽

Nucleocapsid Proteins ◽

Joint Replacement Surgery ◽

Replacement Surgery ◽

Operative Planning ◽

Lymphocyte Responses ◽

Reactive Lymphocytes

Abstract Background Recent studies indicate that, in addition to antibody production, lymphocyte responses to SARS-CoV-2 may play an important role in protective immunity to COVID-19 and a percentage of the general population may exhibit lymphocyte memory due to unknown/asymptomatic exposure to SARS-CoV-2 or cross-reactivity to other more common coronaviruses pre-vaccination. Total joint replacement (TJR) candidates returning to elective surgeries (median age 68 years) may exhibit similar lymphocyte and/or antibody protection to COVID-19 prior to vaccination Methods In this retrospective study, we analyzed antibody titters, lymphocyte memory, and inflammatory biomarkers specific for the Spike and Nucleocapsid proteins of the SARS-CoV-2 virus in a cohort of n=73 returning TJR candidates (knees and/or hips) pre-operatively. Results Peripheral blood serum of TJR candidate patients exhibited a positivity rate of 18.4% and 4% for IgG antibodies specific for SARS-CoV-2 nucleocapsid and spike proteins, respectively. 13.5% of TJR candidates exhibited positive lymphocyte reactivity (SI > 2) to the SARS-CoV-2 nucleocapsid protein and 38% to the spike protein. SARS-CoV-2 reactive lymphocytes exhibited a higher production of inflammatory biomarkers (i.e., IL-1β, IL-6, TNFα, and IL-1RA) compared to non-reactive lymphocytes. Conclusions A percentage of TJR candidates returning for elective surgeries exhibit pre-vaccination positive SARS-CoV-2 antibodies and T cell memory responses with associated pro-inflammatory biomarkers. This is an important parameter for understanding immunity, risk profiles, and may aid pre-operative planning. Trial registration Retrospectively registered.

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