Risk factors associated with surgical site infections following joint replacement surgery: a narrative review

Li, Tao; Zhang, Haining; Chan, Ping Keung; Fung, Wing Chiu; Fu, Henry; Chiu, Kwong Yuen

doi:10.1186/s42836-022-00113-y

Cited by 30 publications

(17 citation statements)

References 79 publications

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“…This approach limited the covariates considered as information related to patients' medications and characteristics such as alcohol and smoking habits are collected in primary care in the UK. as also previously reported [34,[38][39][40][41][42][43]. We observed a decreasing PJI risk with increasing age [34] ( Fig 2 and S1 Fig) as also found in other studies [34]; however the impact of age is controversial as an increased risk of PJI for older patients was reported [44] while other studies reported no relation [45,46].…”

Section: Plos Onesupporting

confidence: 88%

A retrospective study of risk factors, causative micro-organisms and healthcare resources consumption associated with prosthetic joint infections (PJI) using the Clinical Practice Research Datalink (CPRD) Aurum database

2023

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Background Prosthetic joint infection (PJI) is a serious complication after joint replacement surgery and it is associated with risk of mortality and morbidity along with high direct costs. Methods The Clinical Practice Research Datalink (CPRD) data were utilized to quantify PJI incidence after hip or knee replacement up to 5 years after implant and a variety of risk factors related to patient characteristics, medical and treatment history along with characteristics of the original surgery were analyzed through Cox proportional hazard. Results 221,826 patients (individual joints 283,789) met all the inclusion and exclusion criteria of the study; during the study follow-up period (5 years), 707 and 695 PJIs were diagnosed in hip and knee, respectively. Patients undergoing joint replacement surgery during an unscheduled hospitalization had greater risk of PJI than patients whose surgery was elective; similarly, the risk of developing PJI after a secondary hip or knee replacement was about 4 times greater than after primary arthroplasty when adjusted for all other variables considered. A previous diagnosis of PJI, even in a different joint, increased the risk of a further PJI. Distribution of average LoS per each hospitalization caused by PJI exhibited a right skewed profile with median duration [IQR] duration of 16 days [8–32] and 13 days [7.25–32] for hip and knee, respectively. PJIs causative micro-organisms were dependent on the time between initial surgery and infection offset; early PJI were more likely to be multispecies than later (years after surgery); the identification of Gram- pathogens decreased with increasing post-surgery follow-up. Conclusions This study offers a contemporary assessment of the budgetary and capacity (number and duration of hospitalizations along with the number of Accident and Emergency (A&E) visits) posed by PJIs in UK for the national healthcare system (NHS). The results to provide risk management and planning tools to health providers and policy makers in order to fully assess technologies aimed at controlling and preventing PJI. The findings add to the existing evidence-based knowledge surrounding the epidemiology and burden of PJI by quantifying patterns of PJI in patients with a relatively broad set of prevalent comorbidities.

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Section: Plos Onesupporting

confidence: 88%

A retrospective study of risk factors, causative micro-organisms and healthcare resources consumption associated with prosthetic joint infections (PJI) using the Clinical Practice Research Datalink (CPRD) Aurum database

2023

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“…B A infection. On the other hand, studies discovered that advanced age was a protective factor, but male sex was a risk factor for surgical site infection (Baier et al 2019, Resende et al 2021, Li et al 2022. The patient in this study developed grade IV osteoarthritis, which necessitated a total knee arthroplasty.…”

Section: Case Reportmentioning

confidence: 61%

Surgical Site Infection caused by Non-Hemolytic Staphylococcus aureus Following a Total Knee Arthroplasty at a Class C Hospital in Indonesia

Satiyo¹,

Rosa²

2023

FMI

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Highlights: A patient with grade IV osteoarthritis underwent an arthroplasty and developed a surgical site infection caused by Staphylococcus aureus. The treatment for the surgical site infection included antibiotic medications and revision surgery for the previous total knee arthroplasty. Abstract: This article presents a case report of a knee arthroplasty surgical site infection caused by non-hemolytic Staphylococcus aureus. A 56-year-old woman came to the Orthopedic Outpatient Clinic, with the chief complaint of pain in the left knee for the last three years. After being diagnosed with grade IV osteoarthritis, the patient underwent a total knee arthroplasty. The patient had routine post-operative follow-ups at the Orthopedic Outpatient Clinic. However, the patient complained of swelling, pain, and discharge at the surgical site after three months. The patient underwent a second surgery for debridement, implant removal, and interspacer placement. A broad-spectrum antibiotic (gentamicin) was administered while waiting for the culture and antibiotic sensitivity test results. The culture results showed non-hemolytic Staphylococcus aureus presence. The antibiotics were then changed and administered for two weeks according to the culture and antibiotic sensitivity test results. As the results were good, the patient was scheduled for revision surgery for her previous total knee arthroplasty.

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“…In addition, according to a relative report, the surgical time, the volume of bleeding, and the use of bone grafting could all increase the risk of infection. 24 , 25 , 26 Therefore, the above information associated with surgery was collected based on the medical records for THA.…”

Section: Methodsmentioning

confidence: 99%

“…In contrast, the drainage fluid taken on the 3rd day, when the incision dressing was changed, was used for bacterial culture in the controls. In addition, according to a relative report, the surgical time, the volume of bleeding, and the use of bone grafting could all increase the risk of infection 24‐26 . Therefore, the above information associated with surgery was collected based on the medical records for THA.…”

Section: Methodsmentioning

confidence: 99%

The diagnostic value of blood sample NGS in patients with early periprosthetic joint infection after total hip arthroplasty

Zhang

Liu

et al. 2022

International Wound Journal

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The diagnostic value of next‐generation sequencing (NGS) of blood samples from patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA) was evaluated by comparing it with drainage fluid NGS and bacterial culture. The study was designed as a retrospective diagnostic test. Thirty‐six infected patients were diagnosed with PJI according to the Musculoskeletal Infection Society (MSIS) criteria and 57 volunteers were included in our study. NGS and bacterial culture were chosen to detect PJI after THA. Blood samples and drainage fluid were collected for NGS, and the drainage fluid, which was collected at the same time as the NGS drainage fluid sample, was used for bacterial culture. The primary outcomes of interest were sensitivity, specificity, and accuracy. In the infection group, 31 patients showed positive results by blood sample NGS, 33 patients showed positive results by drainage fluid NGS, and 17 patients showed positive bacterial culture results. In the control group, the results of 2 blood sample NGS, 16 drainage fluid NGS, and 3 bacterial cultures were positive. The sensitivity, specificity, and accuracy of the blood sample were 0.86, 0.96, and 0.92, respectively. The sensitivity, specificity, and accuracy of the drainage fluid samples were 0.92, 0.72, and 0.80, respectively. The sensitivity, specificity, and accuracy of bacterial culture were 0.47, 0.95, and 0.79, respectively. The study demonstrated that both the sensitivity and specificity of NGS were higher than those of bacterial culture, regardless of the kind of sample. Compared with drainage fluid NGS, the sensitivity of blood sample NGS was slightly lower (0.86 vs 0.92), but blood sample NGS showed higher specificity (0.96 vs 0.72). In total, the diagnostic value of blood sample NGS was superior to that of drainage fluid NGS and bacterial culture. The majority of infected patients could be identified by blood sample NGS. Moreover, because of its high specificity, blood sample NGS can not only detect infectious bacteria but also distinguish infectious from non‐infectious bacteria, which is dramatically different from using drainage fluid NGS.

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Risk factors associated with surgical site infections following joint replacement surgery: a narrative review

Cited by 30 publications

References 79 publications

A retrospective study of risk factors, causative micro-organisms and healthcare resources consumption associated with prosthetic joint infections (PJI) using the Clinical Practice Research Datalink (CPRD) Aurum database

A retrospective study of risk factors, causative micro-organisms and healthcare resources consumption associated with prosthetic joint infections (PJI) using the Clinical Practice Research Datalink (CPRD) Aurum database

Surgical Site Infection caused by Non-Hemolytic Staphylococcus aureus Following a Total Knee Arthroplasty at a Class C Hospital in Indonesia

The diagnostic value of blood sample NGS in patients with early periprosthetic joint infection after total hip arthroplasty

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