Low Post-Arthroplasty Infection Rate is Possible in Developing Countries: Long-Term Experience of Local Vancomycin Use From A High-Volume Tertiary Knee Center in Iran

Abstract Background: Significant research has been carried out for prevention and also early detection of post-TKA infections. Regarding prevention, utilizing intrawound vancomycin powder in TKA surgery has yielded rather contrasting results in the pertinent literature. Regarding early detection, CDC criteria, although effective in general, are not specifically designed for post-TKA infections. Here, we present a 7-year experience of primary TKA in a high-volume tertiary knee center in Iran, during which intrawound vancomycin powder was used as a routine practice at the end of TKA surgeries. Also, new criteriae are proposed to detect suspected superficial post-TKA infections. Methods: This is a retrospective analysis of primary total knee arthroplasties performed in a tertiary knee center, from March 2011 to December 2018, by a single senior knee surgeon. All patients with follow-up periods of less than one year were excluded from the study. All patient received vancomycin (powder, 1gr) before water-tight closure of the joint capsule. Results: Altogether, 1710 patients were included in the study. Patients were mostly women (male to female ratio: 1 to 4), with a mean age of 64.99 (SD=11.49) years. The overall infection rate was 2.16% (37 of 1710 patients), including 5 periprosthetic deep joint infections and 32 suspected superficial wound infections. Of the 32 suspected superficial infections that were treated with a one-week course of oral antibiotics, all reported disappearance of symptoms, but 2 cases returned with late deep infection. All in all, 7 patients (0.41%) underwent two-stage knee arthroplasty due to deep joint infections. Conclusions: Our experience shows that by utilizing intrawound vancomycin for 7 years as a routine practice along with other measures, we were able to reach relatively low rates of deep post-TKA infections. Howbeit, randomized controlled trials are required to clarify the effect of intrawound vancomycin on post-TKA infection rate.

Download Full-text

Low post-arthroplasty Infection rate is possible in developing countries Long-term Experience of local Vancomycin use from a high-volume tertiary Knee center in Iran

10.21203/rs.3.rs-31299/v2 ◽

2020 ◽

Author(s):

Mohammad Naghi Tahmasebi ◽

Arash Sharafat Vaziri ◽

Fardis Vosoughi ◽

Mohamad Tahami ◽

Majid Khalilizad ◽

...

Keyword(s):

Infection Rate ◽

High Volume ◽

Control Group ◽

Routine Practice ◽

Female Ratio ◽

Vancomycin Powder ◽

Total Knee ◽

One Year ◽

Vancomycin Group ◽

Male To Female

Abstract Background: Utilizing intrawound vancomycin powder in TKA surgery has yielded rather contrasting results in the current literature. Furthermore, CDC criteria, although effective in general, are not specifically designed for post-TKA infections. Here, we present a 7-year experience of vancomycin use in primary TKA in a high-volume tertiary knee center in Iran. Also, new criteria are proposed to detect suspected superficial post-TKA infections. Methods: This is a retrospective analysis of primary total knee arthroplasties performed in a tertiary knee center, from March 2007 to December 2018, by a single senior knee surgeon. All patients with follow-up periods of less than one year were excluded from the study. Since March 2011, all patient received vancomycin (powder, 1gr) before water-tight closure of the joint capsule. Comparison was made between this group and historical control subjects (operated from March 2007 to March 2011). Results: Altogether, 2024 patients were included in the study. The vancomycin and the control group included 1710 and 314 cases respectively. Patients were mostly women (male to female ratio: 1 to 4), with a mean age of 65.20 (SD=10.83) years. In the vancomycin group, the rate of suspected SII (1.87%) and PJI (0.41%) was significantly lower than the control group (P= 0.002). Conclusions: Our experience shows that by utilizing intrawound vancomycin as a routine practice along with other measures, we were able to reach relatively low rates of deep post-TKA infections. Howbeit, randomized controlled trials are required to clarify the effect of intrawound vancomycin on post-TKA infection rate.

Download Full-text

REDUCED INFECTION RATE AFTER ASEPTIC REVISION TOTAL HIP ARTHROPLASTY WITH EXTENDED ORAL ANTIBIOTIC PROTOCOL

Proceedings of IMPRS ◽

10.18060/22733 ◽

2018 ◽

Vol 1 (1) ◽

Author(s):

Amer Mohiuddin, BS ◽

Justin Rice, BA ◽

Mary Ziemba-Davis, BA ◽

R. Michael Meneghini, MD

Keyword(s):

Total Hip Arthroplasty ◽

Infection Rate ◽

Hip Arthroplasty ◽

Joint Infection ◽

Deep Infection ◽

Oral Antibiotic ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Aseptic Revision ◽

One Year

Background and Hypothesis: Periprosthetic joint infection (PJI is a leading cause of failure after aseptic revision total hip arthroplasty (RTHA). While well documented in the primary setting, perioperative antibiotic duration is not well described in RTHA where the risk of PJI was recently reported to be 8% one-year post-revision. The study purpose was to evaluate whether extended oral antibiotic prophylactic protocol minimizes PJI in aseptic RTHA patients compared to the published literature. Project Methods: 169 consecutive aseptic RTHAs performed with modern perioperative and infection-prevention protocols by a single surgeon at a single center were retrospectively reviewed. 80% of patients were discharged on 7-day oral antibiotic prophylaxis while intra-operative cultures were incubating. Infections and reoperations were documented. Results: Average age and BMI were 63 years and 30 kg/m2. 67% percent of patients were ASA-III/IV, signifying the severity of comorbidities in this revision cohort. There we no cases of PJI in the 90-day postoperative period. Ninety-eight percent of cases were infection free at mean follow-up of 45 months. Three (1.8%) cases underwent reoperation for deep infection at 110, 161 and 581 days. Conclusion and Potential Impact: Our observed infection rate of 0.0% is lower than published infection rates following RTHA and a 1.5% infection rate in primary THA in patients with no identifiable risk factors for PJI. Based on this clinically meaningful decrease in PJI in this challenging cohort, we encourage further study regarding extended antibiotic protocol weighed appropriately against potential consequences.

Download Full-text

INTRASITE VANCOMYCIN POWDER AS A PROPHYLACTIC ADJUVANT IN LUMBAR FUSION

Coluna/Columna ◽

10.1590/s1808-185120161501154501 ◽

2016 ◽

Vol 15 (1) ◽

pp. 44-47 ◽

Cited By ~ 7

Author(s):

Jorge Álvaro González Ross ◽

Alfredo Javier Moheno Gallardo ◽

Eulalio Elizalde Martínez ◽

José Manuel Pérez Atanasio ◽

Ruth Martínez Martínez

Keyword(s):

Odds Ratio ◽

Protective Factor ◽

Lumbar Fusion ◽

Deep Infection ◽

Control Group ◽

Case Group ◽

Fusion Surgery ◽

Vancomycin Powder ◽

One Year

ABSTRACT Objective: To identify whether the use of prophylactic intrasite vancomycin as an adjuvant is a protective factor against deep tissue infection of the surgical site. Methods: Retrospective, descriptive, case-control study evaluating 210 patients, of whom 70 received intrasite vancomycin (case group) and 140 were controls. It was made a follow up for at least one year, reviewing the physical and electronic records. Data were tabulated in spreadsheets (Excel) including all variables and the statistical analysis was made with Epi InfoTM 7 to calculate the odds ratio. Results: Seven cases of deep infection occurred in the control group and none was found in the case group (odds ratio [95% confidence interval]: 0.1262 [0.007-2.24], P = 0.1585). Among the predisposing factors, diabetes and surgical time were the most relevant. Conclusions: Intrasite use of vancomycin has a protective effect against deep infection in patients undergoing lumbar fusion surgery without presenting considerable side effects.

Download Full-text

Low post-arthroplasty infection rate is possible in developing countries: long-term experience of local vancomycin use in Iran

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02344-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Mohammad Naghi Tahmasebi ◽

Arash Sharafat Vaziri ◽

Fardis Vosoughi ◽

Mohamad Tahami ◽

Majid Khalilizad ◽

...

Keyword(s):

High Volume ◽

Control Group ◽

Female Ratio ◽

Prevention Measure ◽

Vancomycin Powder ◽

Total Knee ◽

Vancomycin Group ◽

Male To Female

Abstract Background Utilizing intrawound vancomycin powder in TKA surgery has yielded rather contrasting results in the current literature. Furthermore, CDC criteria, although effective in general, are not specifically designed for post-TKA infections. Here, we present a 7-year experience of vancomycin use in primary TKA in a high-volume tertiary knee center in Iran. Also, new criteria are proposed to detect suspected superficial post-TKA infections. Methods This is a retrospective analysis of primary total knee arthroplasties performed in a tertiary knee center, from March 2007 to December 2018, by a single senior knee surgeon. All patients with follow-up periods of less than 1 year were excluded from the study. Since March 2011, all patients received vancomycin (powder, 1 g) before water-tight closure of the joint capsule. A comparison was made between this group and historical control subjects (operated from March 2007 to March 2011). Results Altogether, 2024 patients were included in the study. The vancomycin and the control groups included 1710 and 314 cases respectively. Patients were mostly women (male to female ratio, 1 to 4), with a mean age of 65.20 (SD = 10.83) years. In the vancomycin group, the rate of suspected SII (1.87%) and PJI (0.41%) was significantly lower than the control group (P = 0.002). Conclusions Our experience shows that application of local vancomycin during TKA surgery could be a reasonable infection prevention measure, although prospective randomized studies are required to evaluate its efficacy.

Download Full-text

Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery

PLoS ONE ◽

10.1371/journal.pone.0260146 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0260146

Author(s):

Helen Mary Badge ◽

Tim Churches ◽

Justine M. Naylor ◽

Wei Xuan ◽

Elizabeth Armstrong ◽

...

Keyword(s):

Clinical Guidelines ◽

High Volume ◽

Deep Infection ◽

Total Hip ◽

Joint Replacement Surgery ◽

Replacement Surgery ◽

Post Surgery ◽

Increased Risk ◽

Adjusted Logistic Regression ◽

One Year

Background Total hip and total knee replacement (THR/TKR) are common and effective surgeries to reduce the pain and disability associated with arthritis but are associated with small but significant risks of preventable complications such as surgical site infection (SSI) and venous-thrombo-embolism (VTE). This study aims to determine the degree to which hospital care was compliant with clinical guidelines for the prevention of SSI and VTE after THR/TKR; and whether non-compliant prophylaxis is associated with increased risk of complications. Methods and findings A prospective multi-centre cohort study was undertaken in consenting adults with osteoarthritis undergoing elective primary TKR/THR at one of 19 high-volume Australian public or private hospitals. Data were collected prior to surgery and for one-year post-surgery. Four adjusted logistic regression analyses were undertaken to explore associations between binary non-compliance and the risk of surgical complications: (1) composite (simultaneous) non-compliance with both (VTE and antibiotic) guidelines and composite complications [all-cause mortality, VTE, readmission/reoperation for joint-related reasons (one-year) and non-joint-related reasons (35-days)], (2) VTE non-compliance and VTE outcomes, (3) antibiotic non-compliance and any SSI, and (4) antibiotic non-compliance and deep SSI. Data were analysed for 1875 participants. Guideline non-compliance rates were high: 65% (VTE), 87% (antibiotics) and 95% (composite guideline). Composite non-compliance was not associated with composite complication (12.8% vs 8.3%, adjusted odds ratio [AOR] = 1.41, 95%CI 0.68–3.45, p = 0.40). Non-compliance with VTE guidelines was associated with VTE outcomes (5% vs 2.4%, AOR = 2.83, 95%CI 1.59–5.28,p < 0.001). Non-compliance with antibiotic guidelines was associated with any SSI (14.8% vs 6.1%, AOR = 1.98, 95%CI 1.17–3.62,p = 0.02) but not deep infection (3.7% vs 1.2%,AOR = 2.39, 95%CI 0.85–10.00, p = 0.15). Conclusions We found high rates of clinical variation and statistically significant associations between non-compliance with VTE and antibiotic guidelines and increased risk of VTE and SSI, respectively. Complications after THR/TKR surgery may be decreased by improving compliance with clinical guidelines.

Download Full-text

MRSA-free Elective Orthopaedic Surgery. A Dedicated Elective Orthopaedic Ward Free from MRSA Alexandra Hospital, Redditch, UK

Hip International ◽

10.1177/112070000501500308 ◽

2005 ◽

Vol 15 (3) ◽

pp. 171-176

Author(s):

A. Datta ◽

A. Gardner ◽

K. Bell

Keyword(s):

Infection Rate ◽

High Volume ◽

Deep Infection ◽

Healthcare Associated Infection ◽

Joint Replacement Surgery ◽

Replacement Surgery ◽

Hip Replacements ◽

Great Scrutiny ◽

Orthopaedic Ward ◽

Healthcare Associated

Deep infection complicating arthroplasty surgery carries a heavy financial and emotional burden on any orthopaedic service. The cost of hospital acquired infection is estimated at £1 billion per year by the National Audit Office. Healthcare associated infection is an area currently under great scrutiny. The Alexandra Hospital, Redditch, has developed a dedicated elective orthopaedic ward free from methicillin-resistant Staphylococcus aureus (MRSA) that delivers high quality and high volume major joint replacement surgery through rigorous infection control. Between October 2001 and December 2002, the Alexandra Hospital had an infection rate of 0.21% for total knee replacements compared to the national rate of 2.1% p= 0.002 (CI 0.00005-0.01) The infection rate for total hip replacements was 1.31% compared to 3.8% nationwide. p= 0.01 (CI 0.004- 0.03). The total number of joint replacements performed per year, utilising the same number of elective beds, increased from 482 in 2001 to 629 in 2002. We believe that the MRSA screening policy and subsequent altered bed utilisation have contributed to lowering the rate of infection and improved efficiency. We have developed a safe, effective and efficient orthopaedic unit within the framework of an acute NHS trust. We believe the practical changes and modest investment that have been made within our department can be repeated in other units around the country with relative ease.

Download Full-text

Resection of the coccyx as an outpatient procedure

Orthopedic Reviews ◽

10.4081/or.2020.8813 ◽

2020 ◽

Vol 12 (3) ◽

Author(s):

Ante Matti Kalstad ◽

Rainer G. Knobloch ◽

Vilhjalmur Finsen

Keyword(s):

Spinal Anaesthesia ◽

Inpatient Treatment ◽

Deep Infection ◽

Safe Alternative ◽

Outpatient Procedure ◽

Outpatient Group ◽

Superficial Wound ◽

One Year

We wished to determine if coccygectomy as an outpatient procedure is a safe alternative to inpatient treatment. 68 patients were treated at our institution with coccygectomy as an outpatient procedure during a seven-year period. Out of these 61 (90%) responded to final follow-up questionnaires after a minimum of one year. We recorded satisfaction with the outpatient modality, and compared postoperative complications and long-term satisfaction with patients who had been operated as inpatients during the same period. Out of the 61 patients who responded to final follow up, 39 (64%) were satisfied with having the operation as an outpatient procedure. The patients who would have preferred overnight hospitalization generally felt that traveling home the same day was painful. There was significantly less pain on the journey home if the procedure had been performed under spinal anaesthesia. In terms of complications, there were 10% reoperations due to deep infection in the outpatient group, and 12% superficial wound infections treated with oral antibiotics. The corresponding numbers for the in-patient group were 8% and 14%. The long-term success rate was similar for both groups. 87% of outpatients and 89% of inpatients reported that they would have consented to the operation if they had known the result in advance. Coccygectomy as an outpatient procedure gives similar results to inpatient treatment and can be regarded as an acceptable alternative. Spinal anaesthesia reduces postoperative pain on the journey home.

Download Full-text

Detection of dengue virus in Aedes mosquitoes in Delhi, India

ENTOMON ◽

10.33307/entomon.v44i3.466 ◽

2019 ◽

Vol 44 (3) ◽

pp. 213-218

Author(s):

Suresh Chand Kaushik ◽

Sukhvir Singh ◽

Purnima Srivastava ◽

R. Rajendran

Keyword(s):

Early Intervention ◽

Early Detection ◽

Aedes Aegypti ◽

Dengue Virus ◽

Infection Rate ◽

Transmission Season ◽

Aedes Mosquitoes ◽

Alternative Approach ◽

Human Sera ◽

Minimum Infection Rate

Detection of viruses in human sera particularly in endemic areas is cumbersome and laborious. Therefore, an alternative approach, Immuno-fluorescence assay (IFA) was performed to determine dengue virus (DENV) positivity in mosquitoes. A total of 1055 adult Aedes aegypti female mosquitoes were tested for IFA test against DENV. Minimum infection rate (MIR) for DENV was found higher during August to November 2016 ranging from 10.75 to 20.83. The average yearly MIR was about 6.64. Higher MIR for Ae. aegypti was found in Sarfabad, Noida (12.71) and Khoda Colony, Ghaziabad (11.90). Minimum MIR (4.67) was observed in Sanjay colony (Faridabad). The main contribution of this study resides in the development of a more suitable monitoring system for early detection of viral circulation and to prioritize early intervention in the non-transmission season.

Download Full-text

Toxoplasma gondii in Sheep and Goats from Central Iran

BMC Research Notes ◽

10.1186/s13104-021-05465-3 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Mojtaba Bahreh ◽

Bahador Hajimohammadi ◽

Gilda Eslami

Keyword(s):

Toxoplasma Gondii ◽

Dna Extraction ◽

Infection Rate ◽

Nested Pcr ◽

Prevention Programs ◽

Central Iran ◽

Infection Rates ◽

Sheep And Goats ◽

One Year ◽

Undercooked Meat

Abstract Objective Toxoplasmosis, caused by Toxoplasma gondii, infects humans by consuming infected raw or undercooked meat and foods harboring mature oocysts. In this study, we assessed the prevalence of T. gondii in sheep and goats coming from central Iran. After completing the questionnaire, about one gram of liver or diaphragm tissue was taken as a sample from 90 sheep and 90 goats slaughtered in Yazd Province and stored at – 20 ºC. DNA extraction was done, and then T. gondii was detected using nested PCR. Results This study indicated that the prevalence of T. gondii in all slaughtered animals was 11.6% (21 of 180), including 14.4% (13/90) in sheep and 8.8% (8/90) in goats. The infection rates in liver and diaphragm samples were 12.2% (11/90) and 11.1% (10/90), respectively (p = 0.8163). The infection rate in animals older than one was 16.3% (15/92), and it was 6.8% (6/88) in animals under one year of age. Therefore, no significant differences were found (p = 0.475). Infection rates were 19.5% (18/92) in males and 3.4% (3/88) in females (p = 0.0007). In conclusion, the infection rates of toxoplasmosis in livestock in this area are almost high, and therefore, it is necessary to design appropriate prevention programs to control the disease.

Download Full-text

Analysis of machete cut fractures in Nigerian civilian trauma setting

Scientific Reports ◽

10.1038/s41598-020-79981-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Njoku Isaac Omoke ◽

Omolade Ayoola Lasebikan ◽

Francis Ndubuisi Ahaotu ◽

Ugochukwu Uzodimma Nnadozie ◽

Gregory Chinedu Nwigwe

Keyword(s):

Hemorrhagic Shock ◽

Hospital Care ◽

Case Fatality ◽

Length Of Hospital Stay ◽

Accidental Injury ◽

Early Presentation ◽

Female Ratio ◽

Prolonged Length ◽

Civilian Trauma ◽

One Year

AbstractMachete cut fracture is an important component of morbidity associated with machete injuries although it is under reported. This was a retrospective study to assess machete cut fractures in patients seen in Federal Teaching Hospital Abakaliki and National Orthopaedic Hospital Enugu from 2009 to 2018. There were 91 patients with 154 fractures, male- to- female ratio was 10:1 and mean age was 31.6 ± 14.6 years. The aetiological factors were assault (57, 62.6%), armed robbery (29, 31.9%) and accidental injury (5, 5.5%). The three top bones involved were ulna, metacarpal and finger-phalanx. Fracture was communited in (17, 11.0%), and Gustilo Anderson grade IIIC in (22, 14.3%). Injury to hospital arrival interval later than 6 h was common and correlated with prolonged length of hospital stay (p < 0.001). Anaemia, wound infection and hemorrhagic shock were the three top complications. Nine (5.8%) fractures ended in extremity amputation. Eleven (12.1%) patients left against medical advice, and 5 (5.5%) were transferred. Normal union in 98.3% of the fractures treated and followed up for a minimum of one year. Case fatality rate was 2.2%; none of the patient that died had pre hospital care, and hemorrhagic shock accounted for all the mortality. These call for appropriate injury preventive mechanisms, and improved rates of early presentation of patients to hospital, and pre hospital care.

Download Full-text