Increased Mortality After Prosthetic Joint Infection in Primary THA

Gundtoft, Per Hviid; Pedersen, Alma B; Varnum, Claus; Overgaard, Søren

doi:10.1007/s11999-017-5289-6

Cited by 166 publications

(111 citation statements)

References 27 publications

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“…Despite the great efforts made to provide effective treatment for S. aureus PJIs, it has proven to be associated with high mortality rates 49 . Previous reports of PJI-related one-year mortality have ranged from 4% to 8% [50][51][52] . The one-year mortality rate in this present cohort was 15%, highlighting that S. aureus infections are serious complications of prosthetic joint surgery.…”

Section: Discussionmentioning

confidence: 99%

Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus

Wildeman

Tevell

Eriksson

et al. 2020

Sci Rep

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Staphylococcus aureus is a commensal colonizing the skin and mucous membranes. it can also act as a pathogen, and is the most common microorganism isolated from prosthetic joint infections (PJIs). The aim of this study was to explore the genomic relatedness between commensal and PJI S. aureus strains as well as microbial traits and host-related risk factors for treatment failure. Whole-genome sequencing (WGS) was performed on S. aureus isolates obtained from PJIs (n = 100) and control isolates from nares (n = 101). Corresponding clinical data for the PJI patients were extracted from medical records. No PJI-specific clusters were found in the WGS phylogeny, and the distribution of the various clonal complexes and prevalence of virulence genes among isolates from PJIs and nares was almost equal. Isolates from patients with treatment success and failure were genetically very similar, while the presence of an antibiotic-resistant phenotype and the use of non-biofilm-active antimicrobial treatment were both associated with failure.In conclusion, commensal and PJI isolates of S. aureus in arthroplasty patients were genetically indistinguishable, suggesting that commensal S. aureus clones are capable of causing PJIs. Furthermore, no association between genetic traits and outcome could be demonstrated, stressing the importance of patient-related factors in the treatment of S. aureus PJIs. Worldwide, millions of patients undergo arthroplasty surgery every year, with an expected increase in the coming years 1. Staphylococcus aureus is a major cause of both community-acquired and nosocomial infections, and is regularly reported to be the most common pathogen in prosthetic joint infections (PJIs) 2,3. Risk factors for developing PJIs are related to deficiencies in host defense due to age, obesity, previous surgery, smoking, and immune deficiencies (e.g. rheumatoid arthritis, diabetes mellitus), as well as exogenous factors such as timing and selection of antibiotic prophylaxis, extended operation time, and blood transfusions 4-8. Implant-sparing curative treatment of acute PJIs, whether occurring early in the postoperative period or later through hematogenous seeding, relies on a regimen of debridement, antibiotics, irrigation, and retention of the prosthesis (DAIR) 9. This is possible, provided that the infection has not persisted for more than approximately three weeks and that the isolate is susceptible to biofilm-active antibiotic treatment (i.e. rifampin for staphylococcal infections) 10. However, there are reports suggesting an even shorter time to intervention is needed for a successful treatment 11,12. The impact of risk factors on outcome of treatment has not been fully explored, but recent reports have proposed new risk scores to better guide the choice of treatment 13-15. S. aureus is a commensal of the human skin, nares, and mucous membranes, but also a human pathogen due to its invasive capacity. S. aureus infections occur among both otherwise-healthy individuals and those with co-morbidities, and nasal carriage...

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Section: Discussionmentioning

confidence: 99%

Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus

Wildeman

Tevell

Eriksson

et al. 2020

Sci Rep

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“…Revision risk due to these causes is higher after uncemented THAs (Hailer et al 2010, Stea et al 2014, Dale et al 2019. Such complications may implicate a poorer functional outcome, increased morbidity, and long-term mortality (Lindahl et al 2007, Gundtoft et al 2017, Cnudde et al 2019.…”

Section: Discussionmentioning

confidence: 99%

“…The exception was that uncemented THA in females over 55 years of age had a higher risk of revision due to aseptic loosening, periprosthetic fracture, and dislocation. Patients may have increased long-term mortality after such revisions (Gundtoft et al 2017, Cnudde et al 2019). 3-day and 10-year mortality was similar for all fixations in our study, indicating that perioperative-, short-term, or long-term mortality risk should not dictate what fixation principle to choose in primary THA, even in high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Perioperative, short-, and long-term mortality related to fixation in primary total hip arthroplasty: a study on 79,557 patients in the Norwegian Arthroplasty Register

et al. 2019

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“…The morbidity of undergoing revision surgery for PJI should not be underestimated. When compared to non-infection revisions, PJI patients have a 3.25-fold higher chance of mortality within the first 30 days after surgery [8•], with their overall mortality rate approaching 8–10 and 26% at 5 years [12,13]. …”

Section: Quantifying the Burden Of Periprosthetic Joint Infectionmentioning

confidence: 99%

Current Options and Emerging Biomaterials for Periprosthetic Joint Infection

et al. 2018

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Recent advancements in local antibiotic delivery platforms for preventing and treating PJI include titanium nanotube arrays, synthetic polymers, resorbable hydrogels, and cyclodextrin-based drug delivery options. In particular, cyclodextrins have facilitated great advancements in other clinical disorders and have demonstrated early promise as a future option in the arena of PJI. Novel treatment modalities for PJI optimize the implant surfaces to prevent bacterial biofilm formation or provide prolonged intra-articular antibiotic dosing to eradicate bacteria.

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Increased Mortality After Prosthetic Joint Infection in Primary THA

Abstract: Level III, therapeutic study.

Cited by 166 publications

References 27 publications

Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus

Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus

Perioperative, short-, and long-term mortality related to fixation in primary total hip arthroplasty: a study on 79,557 patients in the Norwegian Arthroplasty Register

Current Options and Emerging Biomaterials for Periprosthetic Joint Infection

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Increased Mortality After Prosthetic Joint Infection in Primary THA

Abstract: Level III, therapeutic study.

Cited by 166 publications

References 27 publications

Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus

Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus

Perioperative, short-, and long-term mortality related to fixation in primary total hip arthroplasty: a study on 79,557 patients in the ­Norwegian Arthroplasty Register

Current Options and Emerging Biomaterials for Periprosthetic Joint Infection

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Perioperative, short-, and long-term mortality related to fixation in primary total hip arthroplasty: a study on 79,557 patients in the Norwegian Arthroplasty Register