Periprosthetic Infection following Primary Hip and Knee Arthroplasty: The Impact of Limiting the Postoperative Surveillance Period

Abstract

BACKGROUND Hip and knee arthroplasty infections are associated with considerable healthcare costs. The merits of reducing the postoperative surveillance period from 1 year to 90 days have been debated. OBJECTIVES To report the first pan-Canadian hip and knee periprosthetic joint infection (PJI) rates and to describe the implications of a shorter (90-day) postoperative surveillance period. METHODS Prospective surveillance for infection following hip and knee arthroplasty was conducted by hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) using standard surveillance definitions. RESULTS Overall hip and knee PJI rates were 1.64 and 1.52 per 100 procedures, respectively. Deep incisional and organ-space hip and knee PJI rates were 0.96 and 0.71, respectively. In total, 93% of hip PJIs and 92% of knee PJIs were identified within 90 days, with a median time to detection of 21 days. However, 11%-16% of deep incisional and organ-space infections were not detected within 90 days. This rate was reduced to 3%-4% at 180 days post procedure. Anaerobic and polymicrobial infections had the shortest median time from procedure to detection (17 and 18 days, respectively) compared with infections due to other microorganisms, including Staphylococcus aureus. CONCLUSIONS PJI rates were similar to those reported elsewhere, although differences in national surveillance systems limit direct comparisons. Our results suggest that a postoperative surveillance period of 90 days will detect the majority of PJIs; however, up to 16% of deep incisional and organ-space infections may be missed. Extending the surveillance period to 180 days could allow for a better estimate of disease burden. Infect Control Hosp Epidemiol 2017;38:147-153.

Surgical site infection surveillance following total knee arthroplasty: Tertiary care hospital experience

“…SSI is defined as an infection that occurs after surgery in the part of the body where the surgery took place within 90 days of surgery [ 6 , 7 ]. Surgical site infection may include purulent drainage from incision, positive fluid or tissue cultures on aseptically obtained samples, wound dehiscence or wound reopened by the surgeon in presence of fever, pain or tenderness, localized swelling, and redness.…”

Trends in health care–associated infections in acute care hospitals in Canada: an analysis of repeated point-prevalence surveys

“…In 2017, a reduction in follow-up period defining surgical site infections occurred, which could reduce the hospital prevalence of these infections. 26 Fourth, laboratory practices have changed over time; for example, laboratories now use more sensitive assays to detect C. difficile infection, which could result in an increase in prevalence. 27 Never theless, by adopting the same methods, timing, similar definitions, hospital type and case mix, we have attempted to minimize the potential for protocol variation.…”

“…(CNISP) provides data on the incidence of selected health careassociated infections and antimicrobial resistant organisms [11][12][13][14][15] and conducted point-prevalence surveys in 2002 and 2009. 16,17 In 2017, we replicated a point-prevalence survey in CNISP hospitals, to provide an up-to-date estimate of the burden of health careassociated infections and antimicrobial-resistant organisms causing these infections in Canadian hospitals, and to describe the trends observed over time in the 3 surveys.…”

Prosthetic joint infection after total hip arthroplasty caused by Lactobacillus paracasei

“…A Canadian study found an incidence of 1.64 infections per 100 hip arthroplasties and 1.52 infections per 100 knee arthroplasties over a 3-year period. 1 Risk factors include obesity, diabetes mellitus, immunosuppressive medications, previous revisions and/or infections of the prosthesis, rheumatoid arthritis and malignancy. 2 Prosthetic joint infections are associated with poor outcomes, with 5-year mortality rates of greater than 20% and threefold higher age-adjusted odds of mortality compared with the general population.…”