Mortality During Total Hip Periprosthetic Joint Infection

Natsuhara, Kyle M.; Shelton, Trevor J.; Meehan, John P.; Lum, Zachary C.

doi:10.1016/j.arth.2018.12.024

Cited by 171 publications

(116 citation statements)

References 26 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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“…It is estimated that they will cost the US healthcare system $1.62 billion in 2020 [1]. In addition, patients have significant morbidity and mortality as a direct result of our current medical and surgical management to treat these infections [2]. In one study, the five year mortality for prosthetic joint infections is over 20% [2].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, patients have significant morbidity and mortality as a direct result of our current medical and surgical management to treat these infections [2]. In one study, the five year mortality for prosthetic joint infections is over 20% [2]. PJIs are hard to treat because of bacterial biofilms on the prostheses.…”

Section: Introductionmentioning

confidence: 99%

Salvage Bacteriophage Therapy for a Chronic MRSA Prosthetic Joint Infection

Doub

Johnson

et al. 2020

Antibiotics

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“…[5] Peri-prosthetic joint infections (PJI), including Surgical Site Infection (SSI), are infective post-operative complications resulting in severe morbidity and mortality. [6] The cumulative incidence of PJI after primary THA and TKA is 1.4% after 10 years [7] and has a five-year mortality rate of 21.12%. [6] PJI is the third most common cause of THA revisions and the most common cause of TKA revisions, worldwide.…”

Section: Introductionmentioning

confidence: 99%

“…[6] The cumulative incidence of PJI after primary THA and TKA is 1.4% after 10 years [7] and has a five-year mortality rate of 21.12%. [6] PJI is the third most common cause of THA revisions and the most common cause of TKA revisions, worldwide. [7] In the USA over 50% of 90-day re-admissions after TKA are as a result of PJI.…”

Section: Introductionmentioning

confidence: 99%

Prevalence Of Staphylococcus Aureus Colonization In Patients For Total Joint Arthroplasty In South Africa

Pietrzak

Maharaj

Mokete

2020

Preprint

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Background: Periprosthetic joint infections are a major source of morbidity and mortality for patients undergoing Total Joint Arthroplasty. Staphylococcus aureus colonization is an independent, modifiable risk factor for periprosthetic joint infections. Post-operative infections are reported to be ten times greater in Staphylococcus aureus carriers than in non-carriers in developed countries though recorded data is lacking for the developing world. This study aims to determine the prevalence of Staphylococcus aureus colonization in patients awaiting Total Joint Arthroplasty in South Africa. Methods: We prospectively assessed 119 patients awaiting Total Knee Arthroplasty and Total Hip Arthroplasty between May and October 2016. We screened three separate anatomical sites on each patient for Staphylococcus aureus. Patients with positive cultures were treated with intranasal mupirocin ointment and chlorhexidine body wash. Univariate and comparative statistical analyses to determine risk factors for colonization was conducted using t-tests, Fisher's exact tests, and chi square analyses.Results: The overall prevalence of Methicillin Sensitive Staphylococcus aureus colonization was 31.9% (n = 38). There were no patients colonized with Methicillin Resistant Staphylococcus aureus . Nasal swabs returned a yield of 81.6%(n=31), with groin swabs and axillary swabs at 39.5% (n=15) and28.9% (n=11) respectively. Eradication was successful in 94.74% (n=36) after five days treatment. All patients (100%) were decolonized after counseling and repeat eradication treatment. The overall complication rate was 7.6% (n=9). The 30-day readmission rate in the Staphylococcus aureuscolonized group was 7.9% (n=3) as opposed to 7.4% (n=6) in the non-colonized cohort. There were no 60-and 90-day readmissions and no cases were revised at a mean follow-up of 2.26 years. Conclusions: The rate of Staphylococcus aureus colonization in patients undergoing elective TotalJoint Arthroplasty in a developing country was 31.9% and is equivalent to reported rates in developed countries. Eradication treatment with combined intranasal mupirocin ointment and chlorhexidine body wash is a successful treatment modality. A larger cohort of patients is recommended to determine risk factors and post-operative septic sequelae in this population group.

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Mortality During Total Hip Periprosthetic Joint Infection

Cited by 171 publications

References 26 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

Salvage Bacteriophage Therapy for a Chronic MRSA Prosthetic Joint Infection

Prevalence Of Staphylococcus Aureus Colonization In Patients For Total Joint Arthroplasty In South Africa

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