Periprosthetic Joint Infections as a Consequence of Bacteremia

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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Is Cefazolin Inferior to Nafcillin for Treatment of Methicillin-Susceptible Staphylococcus aureus Bacteremia?

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00485-11 ◽

2011 ◽

Vol 55 (11) ◽

pp. 5122-5126 ◽

Cited By ~ 87

Author(s):

Shinwon Lee ◽

Pyoeng Gyun Choe ◽

Kyoung-Ho Song ◽

Sang-Won Park ◽

Hong Bin Kim ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Treatment Failure ◽

Propensity Scores ◽

Tertiary Care ◽

Care Hospital ◽

Clinical Failure ◽

Content Type ◽

Staphylococcus Aureus Bacteremia ◽

Matched Case ◽

Control Study

ABSTRACTAbout 20% of methicillin-susceptibleStaphylococcus aureus(MSSA) isolates have a substantial inoculum effect with cefazolin, suggesting that cefazolin treatment may be associated with clinical failure for serious MSSA infections. There are no well-matched controlled studies comparing cefazolin with nafcillin for the treatment of MSSA bacteremia. A retrospective propensity-score-matched case-control study was performed from 2004 to 2009 in a tertiary care hospital where nafcillin was unavailable from August 2004 to August 2006. The cefazolin group (n= 49) included MSSA-bacteremic patients treated with cefazolin during the period of nafcillin unavailability, while the nafcillin group (n= 84) comprised those treated with nafcillin. Treatment failure was defined as a composite outcome of a change of antibiotics due to clinical failure, relapse, and mortality. Of 133 patients, 41 patients from each group were matched by propensity scores. There were no significant differences in baseline characteristics between the matched groups. The treatment failure rates were not significantly different at 4 or 12 weeks (10% [4/41] versus 10% [4/41] at 4 weeks [P> 0.99] and 15% [6/41] versus 15% [6/41] at 12 weeks [P> 0.99]). Cefazolin treatment was interrupted less frequently than nafcillin treatment due to drug adverse events (0% versus 17%;P= 0.02). Cefazolin had clinical efficacy similar to that of nafcillin and was more tolerable than nafcillin for the treatment of MSSA bacteremia.

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MP04-18 POST-OPERATIVE URINARY RETENTION FOLLOWING WEIGHT BEARING JOINT REPLACEMENT SURGERY: INCIDENCE, RISK FACTORS AND OUTCOMES

The Journal of Urology ◽

10.1016/j.juro.2018.02.168 ◽

2018 ◽

Vol 199 (4S) ◽

Author(s):

Haidar Abdul-Muhsin ◽

Nicholas Jakob ◽

Kian Ahmediah ◽

Stephen Cha ◽

Adam Schwartz ◽

...

Keyword(s):

Risk Factors ◽

Urinary Retention ◽

Joint Replacement ◽

Weight Bearing ◽

Joint Replacement Surgery ◽

Replacement Surgery ◽

Incidence Risk ◽

Surgery Incidence

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2137. Risk Factors for Surgical Site Infection After Joint Replacement Surgery: Data from the Swiss National Surveillance System

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1793 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S629-S629

Author(s):

Niccolo Buetti ◽

Andrew Atkinson ◽

Nicolas Troillet ◽

Marie-Christine Eisenring ◽

Marcel Zwahlen ◽

...

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Joint Replacement ◽

Surveillance System ◽

National Surveillance ◽

Site Infection ◽

Joint Replacement Surgery ◽

Replacement Surgery ◽

National Surveillance System

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A commentary on “effects of edaravone on postoperative cognitive function in elderly patients undergoing hip joint replacement surgery: A randomized controlled trial” (Int. J. Surg. 2020; 80:13–18)

International Journal of Surgery ◽

10.1016/j.ijsu.2020.08.020 ◽

2020 ◽

Vol 82 ◽

pp. 34-35

Author(s):

Zhao-Jing Xue ◽

Yi Cheng ◽

Fu-Shan Xue ◽

Yu-Jing Yuan

Keyword(s):

Randomized Controlled Trial ◽

Cognitive Function ◽

Elderly Patients ◽

Hip Joint ◽

Joint Replacement ◽

Controlled Trial ◽

Hip Joint Replacement ◽

Joint Replacement Surgery ◽

Replacement Surgery ◽

Randomized Controlled

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Risk factors for periprosthetic joint infection after primary artificial hip and knee joint replacements

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11013 ◽

2020 ◽

Vol 14 (06) ◽

pp. 565-571

Author(s):

Heng Guo ◽

Chi Xu ◽

Jiying Chen

Keyword(s):

Risk Factors ◽

Knee Joint ◽

Joint Replacement ◽

Joint Infection ◽

History Of Surgery ◽

Surgical Time ◽

Superficial Infection ◽

Hip Joint Replacement ◽

Joint Replacements ◽

History Of

Introduction: We aimed to explore the risk factors for periprosthetic joint infection (PJI) after primary artificial hip and knee joint replacements by performing a case-control study. Methodology: The clinical data of patients receiving primary hip and knee joint replacements were retrospectively analyzed. The case group included 96 patients who suffered from PJI, comprising 42 cases of hip joint replacement and 54 cases of knee joint replacement. Another 192 patients who received joint replacement at the ratio of 1:2 in the same period and did not suffer from PJI were selected as the control group. Differences between the two groups were compared in regard to etiology, pathogen, blood type, urine culture, body mass index (BMI), surgical time, intraoperative blood loss, postoperative 1st day and total drainage volumes, length of hospitalization stay, and history of surgery at the affected sites. Results: Gram-positive bacteria were the main pathogens for PJI. The most common infection after hip joint replacement was caused by Staphylococcus epidermidis, which accounted for 38.10%, while Staphylococcus aureus was mainly responsible for the infection of knee joint (40.74%). High BMI, long surgical time, large postoperative drainage volume, long hospitalization stay, history of surgery at incisions, previous use of immunosuppressants, preoperative hypoproteinemia and superficial infection were independent risk factors (p < 0.05). Conclusions: PJI after primary replacement was mainly caused by gram-positive bacteria, and patients with high BMI, long surgical time, large postoperative drainage volume, long hospitalization stay, history of surgery at incisions, previous use of immunosuppressants, preoperative hypoproteinemia and superficial infection were more vulnerable.

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A prospective study on risk factors for development of surgical site infections at a tertiary care hospital: a two years study

International Surgery Journal ◽

10.18203/2349-2902.isj20180113 ◽

2018 ◽

Vol 5 (2) ◽

pp. 460

Author(s):

Vakamudi Prakash ◽

Ramalinga Reddy Rachamalli ◽

Jithendra Kandati ◽

Sreeram Satish

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Nosocomial Infections ◽

Antibiotic Susceptibility ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Surgical Site Infections ◽

Care Hospital ◽

Multiple Factors ◽

The Common

Background: Surgical site infections (SSI) are the second most common Nosocomial infections after urinary tract infections accounting to 20-25% of Nosocomial infections worldwide. Based on the depth of the infections, SSI is classified by CDC as superficial incisional, deep incisional and organ/space. The development of SSI is dependent upon multiple factors like class of wound, immune status, type of surgery, type of anesthesia; surgical techniques etc and are interplay of multiple factors. Objective of the present study was conducted in identifying the predictors, risk factors and incidence rates of SSI at a tertiary care hospital. The study also identifies the causative bacterial pathogens and their antibiotic susceptibility patternMethods: A prospective cross-sectional study was conducted for a period of two years by department of general surgery involving all patients who underwent surgery, and pre-operative, intra operative and risk factors of the cases were collected using standardized data collection form. Specimens from the infected wounds were collected and processed for isolation of pathogens. Antibiotic susceptibility of pathogens was done using standard guidelines.Results: The incidence of SSI in present study was 25.34% with 81.58% superficial SSI and 18.42% deep SSI. Laparotomy was the common procedure and 63.2% of cases were females and 41-60 years was the most common age group. Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli were the common pathogens and were sensitive to carbapenems, vancomycin and linezolid. Significant association was observed with presence of pre-morbid analysis, presence of drain, use of povidone iodine alone and development of SSI.Conclusions: In present study the incidence of SSI was significantly high in this hospital and associated with premorbid illness, duration of surgery, presence of drain and use of drain at site of surgery. Staphylococcus aureus was the common pathogen and incidence of MRSA is higher than many other reports. A continuous monitoring and surveillance of patients with a predefined protocol will help in early identification of cases with risk of development of SSI. A feedback of appropriate data to surgeons is highly recommended to reduce the SSI rate in developing countries.

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