scholarly journals 239. Sex Differences in Prosthetic Joint Infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S229-S229
Author(s):  
Christine M Mironenko ◽  
Milan Kapadia ◽  
Laura Donlin ◽  
Mark Figgie ◽  
Alberto V Carli ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Treatment Success ◽  
Univariate Analysis ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Exact Test ◽  
Prosthetic Joint ◽  
Implant Retention ◽  
Student’S T

Abstract Background Male sex has been demonstrated to be a non-modifiable risk factor for prosthetic joint infection (PJI) incidence in multiple studies. Given the known anatomical, genetic, and immunological differences between sexes, we compared the clinical characteristics of PJI among men and women. Methods A retrospective cohort of total hip and knee arthroplasty PJIs from 2009 to 2019 were identified using a single institution PJI database. Included cases met the 2013 MSIS criteria. Microbiology, acuity (defined by implant age and symptom days), and surgical outcomes were collected. Success was defined as no further PJI surgery at two years. Continuous variables were tested with either Student’s t test or Mann-Whitney U test. Categorical variables were tested with either Chi-squared test or Fisher’s exact test. Results We identified 1052 PJI patients, of whom 463 (44.0%) were women. In univariate analysis of the total cohort, women were younger (68.1 ± 11.2 vs 66.1 ± 11.8 years, p=0.01), had higher BMI (30.8 ± 7.78 vs 29.8 ± 6.0, p=0.04), and had a higher culture-negative rate (14.5% vs 9.0%, p < 0.01) than men, but no difference was noted in Charlson Comorbidity Index (Table 1). Among hip PJIs, women were likelier than men to present with acute PJI (15.9% vs 8.7%, p=0.03). There were no differences in debridement, antibiotics, and implant retention (DAIR) utilization (48.2% vs 44.1%, p=0.067), and overall treatment success (72.1% vs 71.6%, p=0.9), nor in any subanalysis of acute, hip, or knee PJIs. Conclusion Although females may present differently when diagnosed with PJI, overall outcomes and outcomes with respect to acuity and type of septic revision did not clearly differ in this single-center cohort. Further research in larger cohorts, including additional biomarkers and socioeconomic variables, may further elucidate relationships between sex and PJI characteristics including culture-negativity and symptom acuity. Disclosures All Authors: No reported disclosures

scholarly journals 382. Difference in Pathogens Between Hip and Knee Prosthetic Joint Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S198-S198
Author(s):  
Michael Henry ◽  
Milan Kapadia ◽  
Joseph Nguyen; Barry Brause ◽  
Andy O Miller
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Prosthetic Joint ◽  
Significant Difference ◽  
History Of ◽  
The Difference ◽  
Student’S T

Abstract Background There is contradicting evidence characterizing the difference in pathogens that cause hip and knee prosthetic joint infection (PJI). A possible difference in microbiology may inform choice in antibiotic etiology, prophylaxis, and empiric treatment. We sought to analyze a large cohort of PJIs to see whether there was a significant difference in pathogen between joints. Methods A retrospective cohort of hip and knee PJIs, from 2008 to 2016, were identified by ICD code and surgical codes. The PJI pathogen was identified from synovial or intra-articular tissue cultures. The Student’s t-test was used to compare continuous variables. Chi-square tests were used to compare the categorical variables to joint. Results 807 PJI cases were identified including 444 knees and 363 hips. There were no significant differences between hip and knee PJIs in age, sex, history of PJI, rheumatoid arthritis, Charlson comorbidity index and laterality. There was a higher frequency of diabetes in knee PJIs (25.3%) compared with hip PJIs (15.7%), P < 0.001. No significant difference was found in the prevalence of fungal, staphylococcal (including Staphylococcus aureus), streptococcal, or enterococcal pathogens between hip and knee PJIs. Conclusion In this single-center cohort, hip and knees PJIs are infected with similar pathogens. Multiple site studies are needed to characterize the microbiology of PJIs at a larger scale. Disclosures All authors: No reported disclosures.

scholarly journals Success of Debridement and Implant Retention for Periprosthetic Joint Infection in TKA – Does The Surgeon Matter?

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0020
Author(s):  
Simon W Young ◽  
Mark Zhu ◽  
Saiprasad Ravi ◽  
Richard Cowley ◽  
Chris Luey
Keyword(s):  
Multivariate Analysis ◽  
Lower Limb ◽  
Joint Infection ◽  
Treatment Success ◽  
Univariate Analysis ◽  
First Episode ◽  
Success Rates ◽  
Factors Affecting ◽  
Prosthetic Joint ◽  
Implant Retention

Introduction: Prosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). In acute haematogenous and early post-operative PJI, debridement and implant retention (DAIR) is often the initial treatment and reported success rates vary. The aim of this study was to identify factors affecting the success of DAIR and in particular whether involvement of a lower limb arthroplasty surgeon (LLA) can affect outcome. Method: In a multicentre review over a 15 year period we identified 137 patients undergoing DAIR for first episode PJI following primary TKA at one of three tertiary hospitals. Patients receiving arthroscopic washouts, culture negative PJI, and previous PJIs were excluded. Data on patient, hospital, and surgical factors were identified including age of implant, time to theatre, presence of gross purulence, bacterial subtype, inflammatory markers, relevant comorbidities, whether modular component exchange was performed, and whether a lower limb arthroplasty surgeon performed the procedure. Treatment success was defined as infection eradication characterized by no clinical failure (healed wound and painless joint) or infection recurrence, and no mortality or further surgery due to PJI within minimum two-year follow up post DAIR. Multivariate analysis was performed using a logistic regression model to identify factors associated with successful DAIR. Results: Overall failure rate of DAIR in TKA was 42%. A specialist arthroplasty surgeon was present in 49% of cases. Arthroplasty surgeons performed modular exchange in 92% of cases compared to 57% for other surgeons (RR1.6, P <0.01). On multivariate analysis, involvement of a specialist arthroplasty surgeon was the only factor associated with a significant increase in success of DAIR (OR 2.94, P=0.01). Age of prosthesis less than 90 days and the lack of macroscopic purulence (OR 2.44, p=0.04) increased DAIR success on univariate analysis only. Conclusions: Involvement of a specialist arthroplasty surgeon was associated with a 2.9 times higher success rate for DAIR in TKA. Specialist arthroplasty surgeons were more likely to perform modular exchange. This study suggests surgical technique and thorough debridement is likely to be important to the success of DAIR in TKA.

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

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.

scholarly journals Treatment of Prosthetic Joint Infection with Debridement, Antibiotics and Irrigation with Implant Retention - a Narrative Review

2018 ◽  
Vol 3 (3) ◽  
pp. 108-117 ◽  
Author(s):  
Ricardo Sousa ◽  
Miguel Araújo Abreu
Keyword(s):  
Surgical Technique ◽  
Prosthetic Joint Infection ◽  
Gold Standard ◽  
Selection Criteria ◽  
Joint Infection ◽  
Narrative Review ◽  
Success Rates ◽  
Prosthetic Joint ◽  
Implant Retention ◽  
Patient Selection Criteria

Abstract. Prosthetic joint infection usually requires combined medical and surgical therapy. While revision surgery is widely considered to be the gold standard surgical procedure, debridement, antibiotics and irrigation with implant retention is a very appealing alternative.There is however great controversy regarding its real worth with success rates ranging from 0% to over 90%. A number of different patient and host related variables as well as specific aspects of surgical and medical management have been described as relevant for the final outcome.Along this paper, the authors will provide the readers with a critical narrative review of the currently available literature while trying to provide concise and practical treatment recommendations regarding adequate patient selection criteria, proper surgical technique and optimal antibiotic therapy.

scholarly journals Sudden cardiac death in cancer patients: results from the Paris-Sudden Death Expertise Centre

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Mirabel ◽  
J.S Hulot ◽  
A Lillo-Lelouet ◽  
X Jouven ◽  
E Marijon
Keyword(s):  
Sudden Cardiac Death ◽  
Cancer Patients ◽  
Cardiac Death ◽  
Univariate Analysis ◽  
Population Based ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Multiple Sources ◽  
Exact Test ◽  
Respiratory Causes

Abstract Background Sudden cardiac death (SCD) in cancer patients regardless of their therapies has not been addressed. Methods Population-based registry (2011) via multiple sources to collect every case of SCD in Paris and its suburbs, covering a population of 6.6 million. Data of SCD patients (2011–2017) were analysed by identifying patients with known cancer or past medical history of cancer. Categorical variables were compared using chi-square test or Fisher's exact test; continuous variables using Student t-test or Wilcoxon rank sum test, as appropriate. Results Of 22,570 out of hospital cardiac arrests, 3,311 SCD patients (124 cancer patients and 3,187 non cancer patients) were admitted alive to the hospital and were included in the analysis. Characteristics of patients and cardiac arrest circumstances differed on univariate analysis (Table). The final aetiology of SCD varied: more respiratory causes to SCD (pulmonary embolism and hypoxia) among cancer patients and less acute coronary artery syndromes. Conclusions SCD in cancer patients differs significantly when compared to non-cancer patients. Coronary events are less prominent whereas respiratory causes are common aetiologies in cancer. Funding Acknowledgement Type of funding source: None

scholarly journals Changes in Pediatric Faculty Burnout During the COVID-19 Pandemic

2021 ◽  
Author(s):  
Audrey M. Uong ◽  
Michael D. Cabana ◽  
Janet R. Serwint ◽  
Carol A. Bernstein ◽  
Elaine E. Schulte
Keyword(s):  
Emotional Exhaustion ◽  
Tertiary Care ◽  
Categorical Variables ◽  
Academic Rank ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Exact Test ◽  
Faculty Burnout ◽  
Student’S T ◽  
The Impact

OBJECTIVES To examine the impact of the coronavirus disease 2019 (COVID-19) pandemic and associated workflow changes, such as deployment on pediatric faculty burnout in an early epicenter of the pandemic. We hypothesized burnout would increase during the COVID-19 surge. METHODS We conducted serial cross-sectional surveys of pediatric faculty at an academic, tertiary-care children’s hospital that experienced a COVID-19 surge in the Northeastern United States. Surveys were administered pre-surge (February 2020), during the surge (April 2020), and postsurge (September 2020). The primary outcome was burnout prevalence. We also measured areas of worklife scores. We compared responses between all 3 survey periods. Continuous variables were analyzed by using Student’s t or Mann–Whitney tests, and categorical variables were analyzed by using χ2 or Fisher’s exact test, as appropriate. RESULTS Our response rate was 89 of 223 (40%) presurge, 100 of 267 (37%) during the surge, and 113 of 275 (41%) postsurge. There were no differences in demographics, including sex, race, and academic rank between survey periods. Frequency of burnout was similar in all 3 periods (20% to 26%). The mean scores of emotional exhaustion improved during the surge (2.25 to 1.9; P = .04). CONCLUSIONS Contrary to our hypothesis, we found no changes in pediatric faculty burnout after a COVID-19 surge. Emotional exhaustion improved during the COVID-19 surge. However, these findings represent short-term responses to the COVID-19 surge. Longer-term monitoring of the impact of the COVID-19 surge on pediatric faculty burnout may be necessary for health care organizations to mitigate burnout.

2020 John Charnley Award: The antimicrobial potential of bacteriophage-derived lysin in a murine debridement, antibiotics, and implant retention model of prosthetic joint infection

2020 ◽  
Vol 102-B (7_Supple_B) ◽  
pp. 3-10 ◽  
Author(s):  
Branden R. Sosa ◽  
YingZhen Niu ◽  
Kathleen Turajane ◽  
Kevin Staats ◽  
Vincentius Suhardi ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Bacterial Load ◽  
In Vitro Models ◽  
Periprosthetic Tissue ◽  
Retention Model ◽  
Prosthetic Joint ◽  
Implant Retention

Aims Current treatments of prosthetic joint infection (PJI) are minimally effective against Staphylococcus aureus biofilm. A murine PJI model of debridement, antibiotics, and implant retention (DAIR) was used to test the hypothesis that PlySs2, a bacteriophage-derived lysin, can target S. aureus biofilm and address the unique challenges presented in this periprosthetic environment. Methods The ability of PlySs2 and vancomycin to kill biofilm and colony-forming units (CFUs) on orthopaedic implants were compared using in vitro models. An in vivo murine PJI model of DAIR was used to assess the efficacy of a combination of PlySs2 and vancomycin on periprosthetic bacterial load. Results PlySs2 treatment reduced 99% more CFUs and 75% more biofilm compared with vancomycin in vitro. A combination of PlySs2 and vancomycin in vivo reduced the number of CFUs on the surface of implants by 92% and in the periprosthetic tissue by 88%. Conclusion PlySs2 lysin was able to reduce biofilm, target planktonic bacteria, and work synergistically with vancomycin in our in vitro models. A combination of PlySs2 and vancomycin also reduced bacterial load in periprosthetic tissue and on the surface of implants in a murine model of DAIR treatment for established PJI. Cite this article: Bone Joint J 2020;102-B(7 Supple B):3–10.

Abstract TMP95: Structured Screening for Post-Stroke Cognitive Impairment in the Outpatient Stroke Clinic

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
M. Carter Denny ◽  
Esther A Bonojo ◽  
Evelyn Hinojosa ◽  
Sean I Savitz ◽  
Anjail Z Sharrief
Keyword(s):  
Cognitive Impairment ◽  
Neuropsychological Testing ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Clinical Registry ◽  
Exact Test ◽  
Post Stroke

Introduction: Cognitive impairment (CI) affects 30% of stroke survivors and impacts ability to return to work, drive and perform ADLs. However, there is no standardized screening for post-stroke CI. We implemented CI screening in the STEP (Stroke Transitions, Education and Prevention) clinic. We sought to identify demographic and clinical factors associated with early post-stroke CI. Methods: Eligible pts had ischemic stroke, ICH or TIA, were seen in the STEP clinic from March 2017 to June 2018, and included in the prospective outpatient clinical registry. Screening for post-stroke CI was performed with a Brief Neurocognitive Screen (BNS), a validated 5-minute subset of the Montreal Cognitive Assessment. BNS 0-8 was defined as abnormal (CI present) and 9-12 was defined as normal. Continuous variables were analyzed with student t-tests or Wilcoxon rank-sum tests and categorical variables with Fisher’s exact test. Logistic regression was performed with the significant variables in the univariate analyses. Results: Of 256 patients, 116 completed a BNS at a median of 35 days after hospital discharge. Median NIHSS was 3 (IQR 0.5,6) and follow-up modified Rankin scale (mRS) was 1 (IQR 1,2). Median BNS was 10 (IQR 9,11). Abnormal BNS, was present in 17.2% of pts screened. Of the 20 pts with abnormal BNS, 17 had neuropsychological testing ordered. In the univariate analysis, age, education, admission NIHSS, poor mRS (<2) at follow-up, and atrial fibrillation were significantly associated with early post-stroke CI (Table 1). In the multivariable analysis, only age and follow-up mRS remained significant. Conclusion: Early post-stroke CI is common in stroke pts, even with low NIHSS, and associated with older age and worse mRS. The BNS is a post-stroke CI screening tool than can be performed in stroke clinics. Future studies are needed to assess the feasibility of implementing the BNS across multiple sites and outcomes associated with early identification of post-stroke CI.

Pathways for established prosthetic joint infection

2018 ◽  
pp. 33-40
Author(s):  
Umraz Khan ◽  
Graeme Perks ◽  
Rhidian Morgan-Jones ◽  
Peter James ◽  
Colin Esler ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Acute Infection ◽  
Free Flaps ◽  
Low Grade ◽  
Arthroscopic Debridement ◽  
Prosthetic Joint ◽  
Main Emphasis ◽  
Implant Retention ◽  
Multiple Stages

This chapter discusses pathways for established prosthetic joint infection (PJI) and includes discussion on management of acute infection, surgical management of acute infection (including arthroscopic debridement and implant retention strategies), formal revision surgery, and management of chronic low-grade infection (including management of low-grade infection, antibiotic suppression, and free flaps). The main emphasis of this chapter is to guide the team on what are safe and accepted treatments for patients with confirmed PJI. The most important decision is whether the underlying implant should be retained or replaced. The latter can be in a single or multiple stages.

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