scholarly journals The risk factors of polymicrobial periprosthetic joint infection: a single-center retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hao Li ◽  
Jun Fu ◽  
Erlong Niu ◽  
Wei Chai ◽  
Chi Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Periprosthetic Joint Infection ◽  
Medical Records ◽  
Bacterial Species ◽  
Joint Infection ◽  
Sinus Tract ◽  
Joint Arthroplasty ◽  
Knee Infection ◽  
Tertiary Center ◽  
Gram Negative Organisms

Abstract Background Periprosthetic joint infection is a serious complication after total joint arthroplasty and polymicrobial PJI which compose a subtype of PJI often indicate worse outcomes compared to monomicrobial periprosthetic joint infection. However, a literature review suggested that there were limited number studies evaluating the risk factors of polymicrobial PJI. Materials and methods Between 2015 January and 2019 December, a total of 64 polymicrobial PJI patients and 158 monomicrobial PJI patients in a tertiary center were included in this study and corresponding medical records were scrutinized. The diagnosis of PJI was based on 2014 MSIS criteria. Logistic regression was used to identify the association between various variables and polymicrobial PJI and ROC curve was used to identify their efficiency. Results The prevalence of polymicrobial PJI is 28.3% in our cohorts. After adjusting for the presence of sinus, previous and knee infection, isolation of enterococci (OR, 3.025; 95%CI (1.277,7.164) p = 0.012), infection with atypical organisms (OR, 5.032;95%CI: (1.470,17.229) p = 0.01), infection with gram-negative organisms (OR, 2.255; 95%CI (1.011,5.031) p = 0.047), isolation of streptococcus spp. (OR, 6; 95%CI (2.094,17.194) p = 0.001), and infection with CNS (OfR, 2.183;95%CI (1.148,4.152) p = 0.017) were risk factors of polymicrobial PJI compared to monomicrobial PJI. However, knee infection is related to a decreased risk of polymicrobial PJI with an adjusted OR = 0.479 (p = 0.023). Conclusion This study demonstrated that the prevalence of polymicrobial PJI is 28.3% in PJI patients. Moreover, the presence of sinus tract and previous joint revisions were risk factors for identifying different bacterial species in the intraoperative specimens. Therefore, in these PJI cases, it is necessary to examine multiple specimens of both intraoperative tissue and synovial fluid for increasing the detection rate and obtaining resistance information.

scholarly journals The Risk Factors of Polymicrobial Periprosthetic Joint Infection: A Single-Center Retrospective Cohort Study.

2021 ◽  
Author(s):  
Hao Li ◽  
Jun Fu ◽  
Wei Chai ◽  
LiBo Hao ◽  
Jiying Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Periprosthetic Joint Infection ◽  
Medical Records ◽  
Bacterial Species ◽  
Joint Infection ◽  
Sinus Tract ◽  
Protection Factor ◽  
Tertiary Center ◽  
Gram Negative Organisms ◽  
Culture Positive

Abstract BackgroundPeriprosthetic joint infection is a serious complication after total joint arthroplasty and polymicrobial PJI which compose a subtype of PJI often indicate worse outcomes compared to monomicrobial periprosthetic joint infection. However, a literature review suggested that there were limited number studies evaluating the risk factors of polymicrobial PJI. Materials and methodsBetween 2015 January and 2019 December, a total of 64 polymicrobial PJI patients and 158 monomicrobial PJI patients in a tertiary center were included in this study and corresponding medical records were scrutinized. The diagnosis of PJI was based on 2014 MSIS criteria. Logistic regression was used to identify the association between various variables and polymicrobial PJI and ROC curve was used to identify their efficiency. ResultsThe prevalence of polymicrobial PJI is about 28.28% in our cohorts. After adjusting, the presence of previous revisions (OR, 1.93; p < 0.01), isolation of enterococci (OR, 11.36; p < 0.01), isolation of Escherichia coli (OR, 6.55; p < 0.01), infection with atypical organisms (OR, 9.85; p < 0.01), infection with gram-negative organisms (OR, 6.33; p < 0.01), isolation of streptococcus spp (OR, 1.93; p < 0.01), and infection with CNS (OR, 1.93; p < 0.01) were risk factors of polymicrobial PJI compared to monomicrobial PJI. However, knee infection is a protection factor of polymicrobial PJI with an adjusted OR=0.0479 (p=0.023). ConclusionThis study demonstrated that the prevalence of polymicrobial PJI is about 28.28% in culture-positive PJI patients. Moreover, the presence of sinus tract and previous joint revisions were risk factors for identifying different bacterial species in the intraoperative specimens. Therefore, in these PJI cases, it is necessary to examine multiple specimens of both intraoperative tissue and synovial fluid for increasing the detection rate and obtaining resistance information.

scholarly journals Low frequency of local findings in periprosthetic hip infection caused by low-virulent bacteria compared to periprosthetic knee infection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Takashi Imagama ◽  
Kazushige Seki ◽  
Toshihiro Seki ◽  
Yuta Matsuki ◽  
Kazuhiro Yamazaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Potential Risk ◽  
Bacterial Species ◽  
Joint Infection ◽  
Sinus Tract ◽  
Musculoskeletal Infection ◽  
Knee Infection ◽  
Hip Infection ◽  
Potential Risk Factors ◽  
Periprosthetic Knee Infection

AbstractPeriprosthetic joint infection (PJI) is suspected when local findings such as pain, swelling, hyperthermia, and sinus tract are present. However, the frequency of these findings and the difference between hip and knee are unclear. This study compared the positive rates of local findings in periprosthetic hip infection (PHI) with periprosthetic knee infection (PKI), and aimed to identify potential risk factors associated with the frequency. One hundred one PJI (46 hips and 55 knees) fulfilled the 2018 Musculoskeletal infection society criteria were analysed retrospectively to assess the positive rates of each local finding. Patients were categorized into two groups based on the presence or absence of each local finding, and the influence of two potential risk factors [body mass index (BMI) and C-reactive protein (CRP)] was investigated. Causative bacterial species were divided into high and low-virulent groups, and then culture negative cases were included in low-virulent group. PHI had significantly lower rates of pain, swelling and hyperthermia compared to PKI. Overall, up to one-third of PHI had pain as only symptom. High BMI and low-virulent bacteria were associated with lower frequency of swelling and hyperthermia in PHI. CRP had no impact on positive rates of local findings. PHI was oligosymptomatic in a significant percentage of cases. This is particularly important in obese patients and infection by low-virulent bacteria.

scholarly journals Comparison of the success rate after debridement, antibiotics and implant retention (DAIR) for periprosthetic joint infection among patients with or without a sinus tract

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Wang Deng ◽  
Rui Li ◽  
Hongyi Shao ◽  
Baozhan Yu ◽  
Jiying Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Success Rate ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Sinus Tract ◽  
Success Rates ◽  
Implant Retention ◽  
Potential Risk Factors

Abstract Background The relevance between the presence of a sinus tract and the failure risk after debridement, antibiotics and implant retention (DAIR) for periprosthetic joint infection (PJI) after hip or knee arthroplasty is still unclear. This study aimed to compare the success rate of DAIR between patients with or without a sinus tract and to explore the possible risk factors for failure after DAIR in patients with a sinus tract. Methods Consecutive DAIR cases for PJI after hip or knee arthroplasty between January 2009 and June 2019 with a minimum 1-year follow-up in two tertiary joint arthroplasty centers were included. Patients were classified into the sinus tract group and the non-sinus tract group according to the presence of a sinus tract. The success rate after DAIR were compared using Kaplan-Meier survival analysis. Potential risk factors for failure in the sinus group were also explored. Results One hundred seven patients were included. At a median 4.4 years of follow-up, 19 of 52 (36.5%) cases failed in the sinus tract group, while 15 of 55 (27.3%) cases failed in the non-sinus tract group. The 1-year and 5-year cumulative success rates were 71.2% (95% confidence interval (CI): 59.8-84.6%) and 56.8% (95% CI: 42.6-75.7%) in the sinus tract group, respectively, which were similar to the counterparts in the non-sinus tract group (P = 0.214). Among patients with a sinus tract, DAIR with the exchange of modular components showed a higher success rate (75.8% versus 47.4%, P = 0.038). Conclusions The presence of a sinus tract does not affect the success rate of DAIR. Modular component exchange in DAIR was proposed for patients with a sinus tract for an improved infection control rate.

scholarly journals Reducing periprosthetic joint infection: what really counts?

Joints ◽  
2015 ◽  
Vol 03 (04) ◽  
pp. 208-214 ◽  
Author(s):  
Giuseppe Solarino ◽  
Antonella Abate ◽  
Giovanni Vicenti ◽  
Antonio Spinarelli ◽  
Andrea Piazzolla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Prophylaxis ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Surgical Techniques ◽  
Joint Arthroplasty ◽  
Implant Failure ◽  
Present Review ◽  
Preoperative Period ◽  
Human Host

Periprosthetic joint infection (PJI) remains one of the most challenging complications after joint arthroplasty. Despite improvements in surgical techniques and in the use of antibiotic prophylaxis, it remains a major cause of implant failure and need for revision. PJI is associated with both human host-related and bacterial agentrelated factors that can interact in all the phases of the procedure (preoperative, intraoperative and postoperative). Prevention is the first strategy to implement in order to minimize this catastrophic complication.The present review focuses on the preoperative period, and on what to do once risk factors are fully understood and have been identified.

scholarly journals 7 Management of Periprosthetic Joint Infection

2021 ◽  
Keyword(s):  
Decision Making ◽  
Periprosthetic Joint Infection ◽  
Total Joint Arthroplasty ◽  
Joint Infection ◽  
Joint Arthroplasty ◽  
Orthopaedic Surgeon ◽  
Systemic Complications ◽  
Surgical Decision ◽  
Surgical Options ◽  
Surgical Decision Making

Periprosthetic joint infection (PJI) continues to be a devastating problem in the field of total joint arthroplasty. There are a number of surgical options to decide from and management decisions are based upon the interplay between host, pathogen, and surgeon characteristics. The goal of management is to maximize function, prevent systemic complications, and eradicate infection. Throughout this chapter we will discuss the most relevant recent literature and guiding theories to assist the treating orthopaedic surgeon in the surgical decision-making process.

scholarly journals Feasibility of Using Common Data Model for Orthopedic Research: Analysis of Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty

2020 ◽  
Author(s):  
Young Ju Chae ◽  
Jin Ho Shin ◽  
Sung Jae Jung ◽  
Hyun Sik Gong
Keyword(s):  
Risk Factors ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Social Factors ◽  
Data Model ◽  
Joint Infection ◽  
Joint Arthroplasty ◽  
Common Data Model ◽  
Laboratory Results

Abstract Background: Common data model (CDM) is a standardized data structure defined to efficiently use different sources in hospitals. A study using the CDM is scarce for orthopedic outcome researches due to the complexity of variables. We aimed to test the feasibility of applying CDM in the orthopedic field and analyzed risk factors for periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) using CDM.Methods: We undertook a retrospective cohort study of all primary and revision hip and knee TJAs at our institution from January 2003 to October 2017. We identified potential risk factors for PJI after TJAs in the literatures, which included preoperative demographic/social factors, previous medical history, intraoperative factors, laboratory results and others. The data sourced from EMR was extracted, transformed, and loaded into CDM.Results: Variables such as demographic/social factors, medical history and laboratory results could be converted into CDM, but the other known risk factors could not. In total, 12,320 primary hip and knee TJAs and 120 revision arthroplasties were identified. Among them, 34 revisions were done because of PJI. Risk factors of PJI were hypertension and urinary tract infection after total hip arthroplasty, and age (70-79 years), male sex, anemia, steroid use, and urinary tract infection after total knee arthroplasty. Conclusions: This study demonstrates that orthopedic outcome researches using CDM is feasible although data converting to CDM was possible for limited factors. Further data transforming technologies need to be developed to analyze more factors relevant to orthopedic area, such as intraoperative factors and imaging findings.

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