Infection risk prevention following total knee arthroplasty

Levent, T.; Vandevelde, D.; Delobelle, J.-M.; Labourdette, P; Létendard, J; Lesage, Pauline; Lecocq, P; Dufour, Mary C.

doi:10.1016/j.otsr.2009.10.010

Cited by 28 publications

(12 citation statements)

References 14 publications

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“…We next compared independent risk factors for infection in our patients to those in previously published studies that provided such detail (►Table 4). Compared with several different previously published studies, our population was more likely to be ASA > 2 (OR, 3.0-37.8; p < 0.001) [13][14][15]17,29,31,33,34 and to have a BMI > 30 (OR, 2.0-14.6; p 0.001). 15,17,29,33 We also demonstrate a higher incidence of immunosuppressed patients (OR, 5.7; p < 0.001) 33 and rheumatoid arthritis (OR, 1.2-4.4; p < 0.001-0.352).…”

Section: Population Comorbidity Analysiscontrasting

confidence: 56%

“…Large-scale database studies have demonstrated certain comorbidities to be significantly associated with an increased risk of SSI. [12][13][14][15][16][17][18] These include, but are not limited to, (1) American Society of Anesthesiologists (ASA) class > 2, (2) body mass index (BMI) > 30 kg/m 2 , (3) immune suppression, (4) rheumatoid arthritis, and (5) diabetes mellitus. [19][20][21][22][23][24] In our inner-city tertiary referral institution, which has been a focus of epidemic community-acquired MRSA (CA-MRSA) for over a decade, 25,26 it is perceived that many patients undergoing TKA have several comorbidities which substantially increase risk of SSI and that exposure to resistant organisms is high.…”

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confidence: 99%

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Modified Protocol Decreases Surgical Site Infections after Total Knee Arthroplasty

et al. 2015

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We investigate the effectiveness of a comprehensive aseptic protocol in reducing surgical site infection (SSI) after knee arthroplasty in a single medical center with a high prevalence of MRSA. A database of all patients in a single center undergoing primary knee arthroplasty between 2005 and 2011 was reviewed for SSI using Centers for Disease Control criteria and AAOS guidelines. All patients were treated with an aseptic protocol consisting of the following: preoperative 2% mupirocin nasal ointment and 0.4% chlorhexidine surgical site wipes, modified instrument care, perioperative prophylactic vancomycin and cefazolin, and surgical site skin preparation with chlorhexidine, alcohol, and iodophor. We compare our protocol total knee arthroplasty SSI rate to our institutional historical control (2001-2004) and to contemporary literature. Among 1,224 patients, 70% were ASA class >2 and 64% had a body mass index (BMI) > 30 kg/m(2). We found an overall 0.49% infection rate, significantly lower than that of our institutional historical control (0.49 vs. 2.24%, p < 0.001; odds ratio [OR], 0.21; number needed to treat [NNT], 145) and seven recently published reports (p < 0.001-0.042; OR, 0.07-0.42). Compared with these reports, significantly more of our patients were ASA class > 2, BMI > 30 kg/m(2), immunosuppressed, or had rheumatoid arthritis. Our aseptic protocol decreases SSI in a high-risk population undergoing knee arthroplasty in a medical center and community with a high prevalence of MRSA.

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Section: Population Comorbidity Analysiscontrasting

confidence: 56%

mentioning

confidence: 99%

Modified Protocol Decreases Surgical Site Infections after Total Knee Arthroplasty

et al. 2015

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“…Diabetes mellitus is also associated with SSI in patients undergoing arthroplasty [12,13], although the degree of attributable risk for infection independent of obesity is difficult to establish [6,30]. These risks may increase morbidity and mortality while also adding the burden of increased cost [15,18]. Additional patient risk factors include, but are not limited to, tobacco use, poor dentition, immunosuppression, methicillin-resistant Staphylococcus aureus (MRSA) colonization, malnutrition, inflammatory disease, and coagulopathy [5,6,18,21,23,25].…”

Section: Introductionmentioning

confidence: 99%

“…These risks may increase morbidity and mortality while also adding the burden of increased cost [15,18]. Additional patient risk factors include, but are not limited to, tobacco use, poor dentition, immunosuppression, methicillin-resistant Staphylococcus aureus (MRSA) colonization, malnutrition, inflammatory disease, and coagulopathy [5,6,18,21,23,25].…”

Section: Introductionmentioning

confidence: 99%

Medical Comorbidities Are Independent Preoperative Risk Factors for Surgical Infection After Total Joint Arthroplasty

Everhart

Altneu

Calhoun

2013

Clinical Orthopaedics &Amp; Related Research

138

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Background Surgical site infection (SSI) after total joint arthroplasty (TJA) is a major cause of morbidity. Multiple patient comorbidities have been identified as SSI risk factors including obesity, tobacco use, diabetes, immunosuppression, malnutrition, and coagulopathy. However, the independent effect of multiple individual patient factors on risk of subsequent periprosthetic infection is unclear. Questions/purposes The purposes of this study are (1) to collect data on several preestablished infection risk factors in addition to SSI-related data on a large TJA cohort; and (2) to use multivariate modeling on previously established patient risk factors to determine independent preoperative predictors of SSI.Methods We reviewed records of patients undergoing TJA from January 1, 2010, to July 30, 2012. Confirmation of SSI followed published guidelines for superficial, deep, and periprosthetic. A total of 29 culture-positive SSIs (1.5% total) and 1846 controls were identified. The prevalence of known patient-specific infection risk factors was determined for both infected cases and healthy control subjects followed by multiple regression analysis to determine independent risk. Results Isolated organisms consisted of methicillinresistant Staphylococcus aureus (MRSA; 34.5%) followed by gram-negative rods (31.0%). After adjusting for anatomic site, independent risk factors for infection include: revision surgery (odds ratio [OR]

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“…An zahlreichen einzelnen Beispielen konnte nachgewiesen werden, dass sich die "Protokolltreue", d. h. das personalseitige Einhalten der vereinbarten Hygienevorgaben durch Schulungsmaßnahmen, verbessern lässt, zum Beispiel im Bereich der Hän-dehygiene, der Antibiotikaprophylaxe, des Verhaltens im OP oder der OP-Technik [287,[397][398][399][400][401].…”

Section: Mitarbeiterschulungunclassified

Prävention postoperativer Wundinfektionen

2018

Bundesgesundheitsbl

153

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Infection risk prevention following total knee arthroplasty

Abstract: Level IV. Prospective prognostic study.

Cited by 28 publications

References 14 publications

Modified Protocol Decreases Surgical Site Infections after Total Knee Arthroplasty

Modified Protocol Decreases Surgical Site Infections after Total Knee Arthroplasty

Medical Comorbidities Are Independent Preoperative Risk Factors for Surgical Infection After Total Joint Arthroplasty

Prävention postoperativer Wundinfektionen

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