Antibiotic Prophylaxis and the Risk of Surgical Site Infections following Total Hip Arthroplasty: Timely Administration Is the Most Important Factor

Kasteren, M.E.E. van; Manniën, Judith; Ott, Alewijn; Kullberg, Bart‐Jan; Boer, Annette S. de; Gyssens, Inge C.

doi:10.1086/512192

Cited by 240 publications

(141 citation statements)

References 33 publications

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“…The optimum time for prophylactic antibiotic administration is within an hour prior to the surgery, in order to reach the minimal inhibitory concentration in the end organs during the operation (44). In certain conditions such as prolonged surgical duration beyond the half-life of the antibiotic or when excessive blood loss occurs during the surgery, a second dose of antibiotic is required.…”

Section: Prophylactic Antibioticsmentioning

confidence: 99%

Prevention of Periprosthetic Joint Infection

Rezapoor

Parvızı

2015

The Journal of Arthroplasty

121

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Section: Prophylactic Antibioticsmentioning

confidence: 99%

Prevention of Periprosthetic Joint Infection

Rezapoor

Parvızı

2015

The Journal of Arthroplasty

121

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“…Over the last 50 years, numerous strategies have been used to reduce the risk of PJIs, including preoperative bacterial decolonization, incision site antisepsis, more intensive antimicrobial prophylaxis regimens, laminar airflow operating room environment, ultraviolet light in the operating room, antibiotic cement, antibiotic-impregnated closure material, intraoperative local antibiotic application, and contained surgeon exhaust suits, strategies that focus on optimizing the hospital environment and surgical technique [4,6,8,9,12,23]. In addition to these measures, there are patient-related and procedure-related factors that have been reported to increase the risk for PJI: diabetes mellitus, rheumatoid arthritis, psoriasis, immune-compromised state, malignancy, corticosteroid use, obesity, tobacco use, emergent or semiemergent surgery, Staphylococcus aureus colonization, revision surgery, and operating time [1,25].…”

Section: Introductionmentioning

confidence: 99%

The Otto Aufranc Award: Modifiable versus Nonmodifiable Risk Factors for Infection After Hip Arthroplasty

Maoz

Phillips

Bosco

et al. 2015

Clinical Orthopaedics &Amp; Related Research

162

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Background Periprosthetic joint infections (PJIs) are associated with increased morbidity and cost. It would be important to identify any modifiable patient-and surgicalrelated factors that could be modified before surgery to decrease the risk of PJI. Questions/purposes We sought to identify and quantify the magnitude of modifiable risk factors for deep PJIs after primary hip arthroplasty. Methods A series of 3672 primary and 406 revision hip arthroplasties performed at a single specialty hospital over a 3-year period were reviewed. All deep PJIs were identified using the Centers for Disease Control and Prevention case definitions (ie, occurs within 30-90 days postoperatively, involves deep soft tissues of the incision, purulent drainage, dehiscence and fever, localized pain or tenderness). Univariate and multivariate analyses determined the association between patient and surgical risk factors and PJIs. For the elective patients, the procedure was performed on the day of admission (''same-day procedure''), whereas for the fracture and nonelective patients, the procedure was performed 1 or more days postadmission (''nonsame-day procedure''). Staphylococcus aureus colonization, tobacco use, and body mass index (BMI) were defined as patient-related modifiable risk factors. Results Forty-seven (1.3%) deep PJIs were identified. Infection developed in 20 of 363 hips of nonsame-day procedures and 27 of 3309 same-day procedures (p = 0.006). There were eight (2%) infections in the revision group. After controlling for confounding variables, our multivariate analysis showed that BMI 3 40 kg/m 2 (odds ratio [OR], 4.13; 95% confidence interval [CI], 1.3-12.88; p = 0.01), operating time [ 115 minutes (OR, 3.38; 95% CI, 1.23-9.28; p = 0.018), nonsame-day surgery (OR, 4.16; 95% CI, 1.44-12.02; p = 0.008), and revision surgery (OR, 4.23; 95% CI, 1.67-10.72; p \ 0.001) are significant risk factors for PJIs. Tobacco use and S aureus colonization were additive risk factors when combined with other significant risk factors (OR, 12.76; 95% CI,; p = 0.017). Conclusions Nonsame-day hip and revision arthroplasties have higher infection rates than same-day primary surgeries. These characteristics are not modifiable and should be categorized as a separate cohort for complication-reporting purposes. Potentially modifiable risk factors in our patient population include operating time, elevated BMI, tobacco use, and S aureus colonization. Modifying risk factors may

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“…Moreover, they did not take into account the effects of surgical antibiotic prophylaxis (SAP) on the development of SSI after gastric surgery, and this might be one of most important risk factors. 11 We performed a prospective multicenter study of a large number of patients undergoing gastric surgery in Korea, to characterize SSI and identify the risk factors associated with SSI, including variables of SAP quality.…”

mentioning

confidence: 99%

Prospective Nationwide Surveillance of Surgical Site Infections after Gastric Surgery and Risk Factor Analysis in the Korean Nosocomial Infections Surveillance System (KONIS)

Kim

Song

et al. 2012

Infect. Control Hosp. Epidemiol.

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'" for the Korean Nosocomial Infections Surveillance System (KONIS)OBJECTIVE. To evaluate the risk factors for surgical site infection (SSI) after gastric surgery in patients in Korea. DESIGN. A nationwide prospective multicenter study.SETTING. Twenty university-affiliated hospitals in Korea.METHODS. The Korean Nosocomial Infections Surveillance System (KONIS), a Web-based system, was developed. Patients in 20 Korean hospitals from 2007 to 2009 were prospectively monitored for SSI for up to 30 days after gastric surgery. Demographic data, hospital characteristics, and potential perioperative risk factors were collected and analyzed, using multivariate logistic regression models.RESULTS. Of the 4,238 case patients monitored, 64.9% (2,752) were male, and mean age (±SD) was 58.8 ( ± 12.3) years. The SSI rates were 2.92, 6.45, and 10.87 per 100 operations for the National Nosocomial Infections Surveillance system risk index categories of 0, 1, and 2 or 3, respectively. The majority (69.4%) of the SSIs observed were organ or space SSIs. The most frequently isolated microorganisms were Staphylococcus aureus and Klebsiella pneumoniae. CONCLUSIONS. Male sex, inappropriate SAP, and operation-related variables are independent risk factors for SSI after gastric surgery. Infect Control Hosp Epidemiol 2012;33(6):572-580Surgical site infections (SSIs) are the leading cause of noslance system for nosocomial infections, the Korean Nosoocomial infection. The development of SSIs results in procomial Infections Surveillance System (KONIS), was devellonged hospital stay, extra costs, and increased morbidity and oped in Korea in 2006. 5 Gastric surgery was one of the most mortality. 1,2 A system for infection surveillance and to provide frequently performed surgical procedures in Korea in 2009 feedback to practicing surgeons regarding infection rates was (39.64 operations per 100,000 population); 6 when employing effective in reducing rates of SSI in previous studies. 3 ' 4 In surveillance for SSIs and risk factor analyses in Korea, gastric addition, it is important to establish the risk factors for SSI, surgery was given priority over other surgical procedures. A to prevent infectious complications after surgery by improvnumber of studies have shown that wound class, patient age, ing correctable factors.body mass index (BMI), duration of operation, laparoscopic A nationwide prospective multicenter Web-based surveilprocedure, and multiple doses of prophylactic antibiotics Affiliations:

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Antibiotic Prophylaxis and the Risk of Surgical Site Infections following Total Hip Arthroplasty: Timely Administration Is the Most Important Factor

Abstract: This study suggests that intervention programs in search of amendable factors to prevent SSI should focus on timely administration of antibiotic prophylaxis.

Cited by 240 publications

References 33 publications

Prevention of Periprosthetic Joint Infection

Prevention of Periprosthetic Joint Infection

The Otto Aufranc Award: Modifiable versus Nonmodifiable Risk Factors for Infection After Hip Arthroplasty

Prospective Nationwide Surveillance of Surgical Site Infections after Gastric Surgery and Risk Factor Analysis in the Korean Nosocomial Infections Surveillance System (KONIS)

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