Trends in surgical site infections following orthopaedic surgery

Lamagni, Theresa; Elgohari, Suzanne; Harrington, Pauline

doi:10.1097/qco.0000000000000143

Cited by 35 publications

(27 citation statements)

References 25 publications

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“…Antimicrobial prophylaxis in surgery is one of the most effective measures for preventing surgical site infections [7]. However, concerns arise about the appropriateness of currently recommended regimens for joint replacement surgery, as recent studies indicate that they may have inadequate activity against a substantial proportion of bacteria involved in surgical site infections, ranging from 54% to 68% [22,23,37,38]. The shifts in microbial aetiology observed in our investigation argue in favour of reassessing antimicrobial prophylaxis strategies.…”

Section: Discussionmentioning

confidence: 77%

Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study

Benito

Franco

Ribera

et al. 2016

Clinical Microbiology and Infection

184

125

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It is important to know the spectrum of the microbial aetiology of prosthetic joint infections (PJIs) to guide empiric treatment and establish antimicrobial prophylaxis in joint replacements. There are no available data based on large contemporary patient cohorts. We sought to characterize the causative pathogens of PJIs and to evaluate trends in the microbial aetiology. We hypothesized that the frequency of antimicrobial-resistant organisms in PJIs has increased in the recent years. We performed a cohort study in 19 hospitals in Spain, from 2003 to 2012. For each 2-year period (2003-2004 to 2011-2012), the incidence of microorganisms causing PJIs and multidrug-resistant bacteria was assessed. Temporal trends over the study period were evaluated. We included 2524 consecutive adult patients with a diagnosis of PJI. A microbiological diagnosis was obtained for 2288 cases (90.6%). Staphylococci were the most common cause of infection (1492, 65.2%). However, a statistically significant rising linear trend was observed for the proportion of infections caused by Gram-negative bacilli, mainly due to the increase in the last 2-year period (25% in 2003-2004, 33.3% in 2011-2012; p 0.024 for trend). No particular species contributed disproportionally to this overall increase. The percentage of multidrug-resistant bacteria PJIs increased from 9.3% in 2003-2004 to 15.8% in 2011-2012 (p 0.008), mainly because of the significant rise in multidrug-resistant Gram-negative bacilli (from 5.3% in 2003-2004 to 8.2% in 2011-2012; p 0.032). The observed trends have important implications for the management of PJIs and prophylaxis in joint replacements.

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Section: Discussionmentioning

confidence: 77%

Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study

Benito

Franco

Ribera

et al. 2016

Clinical Microbiology and Infection

184

125

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“…Use of parental antibiotics in patients hospitalized in Turkey has been legally subject to supervision by infectious disease specialists since 2003 [11]. In addition, various factors such as physical conditions, and health team numbers and training levels affect the development of infections, and it is a known fact that ideal conditions are not being achieved even in many university or education-research hospitals in Turkey [12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

An Evaluation of Surgical Prophylaxis Procedures in Turkey: A Multi-Center Point Prevalence Study

Kaya¹,

Aktas²,

Şenbayrak³

et al. 2016

Eurasian J Med

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Objective: The purpose of this study was to evaluate compliance with guidelines in surgical prophylaxis (SP) procedures in Turkey. Materials and Methods:A point prevalence study involving 4 university, 5 education and research and 7 public hospitals was performed assessing compliance with guidelines for antibiotic use in SP. Compliance was based on the "Clinical Practice Guidelines for Antimicrobial Surgery (CPGAS) 2013" guideline.Results: Sixteen centers were included in the study, with 166 operations performed at these being evaluated. Parenteral antibiotic for SP was applied in 161 (96.9%) of these. Type of antibiotic was inappropriate in 66 (40.9%) cases and duration of use in 47 (29.1%). The main antibiotics used inappropriately in SP were ceftriaxone, glycopeptides and aminoglycosides. No significant difference was observed between secondary and tertiary hospitals in terms of inappropriate selection. Duration of prophylaxis was also incompatible with guideline recommendations in approximately half of surgical procedures performed in both secondary and tertiary hospitals, however statistical significance was observed between institutions in favor of tertiary hospitals. ÖzAmaç: Bu çalışmanın amacı, ülkemizdeki cerrahi proflaksi uygulamalarının rehberlere uygunluğunun değerlendirilmesidir. Gereç ve Yöntem:Bu amaçla, 4 üniversite, 5 eğitim-araştırma ve 7 devlet hastanesini içine alan bir nokta prevalans çalışması yapılmıştır. Cerrahi proflaksideki uygunluğunun değerlendiril-mesinde "Clinical Practice Guidelines for Antimicrobial Surgery (CPGAS) 2013" rehberi baz alınmıştır. Bulgular:Toplam 16 merkez çalışmaya katılmış olup, bu merkezlerdeki 166 operasyon değerlendirilmiştir. Bunların 161'inde (%96,9) cerrahi proflaksi amacıyla parenteral antibiyotik uygulanmıştır. Olguların 66'sında (%40,9) kullanılan antibiyotiğin türü, 47'sinde (%29,1) ise süresi uygunsuz bulunmuştur. Cerrahi proflakside uygunsuz kullanılan antibiyotikler olarak en çok; seftriakson, glikopeptidler ve aminoglikozitler dikkati çekmektedir. İkinci ve 3.basamak sağlık kuruluşları arasında antibiyotik seçimindeki uygunsuzluk açısından anlamlı bir fark görülmemiştir. Cerrahi uygulamaların yaklaşık yarısında proflaktik antibiyotiklerin süresi rehber önerileriyle uyumlu bulunmamış olmakla birlikte; istatistiksel olarak 3.basamak hastanelerinin lehine bir durum olduğu görülmüştür.

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“…Of these, Enterobacteriaceae are challenging because they resist a wide range of antibiotics. [25][26][27] When bone tissue is infected, the bacteria induce an acute inflammatory reaction. The bacteria and inflammation affect the periosteum and spread within the bone causing bone necrosis.…”

Section: General Pathophysiologymentioning

confidence: 99%

Osteomyelitis: Recent advances in pathophysiology and therapeutic strategies

Birt

Anderson

Toby

et al. 2017

Journal of Orthopaedics

176

127

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This review article summarizes the recent advances in pathogenic mechanisms and novel therapeutic strategies for osteomyelitis, covering both periprosthetic joint infections and fracture-associated bone infections. A better understanding of the pathophysiology including the mechanisms for biofilm formation has led to new therapeutic strategies for this devastating disease. Research on novel local delivery materials with appropriate mechanical properties, lower exothermicity, controlled release of antibiotics, and absorbable scaffolding for bone regeneration is progressing rapidly. Emerging strategies for prevention, early diagnosis of low-grade infections, and innovative treatments of osteomyelitis such as biofilm disruptors and immunotherapy are highlighted in this review.

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Trends in surgical site infections following orthopaedic surgery

Cited by 35 publications

References 25 publications

Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study

Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study

An Evaluation of Surgical Prophylaxis Procedures in Turkey: A Multi-Center Point Prevalence Study

Osteomyelitis: Recent advances in pathophysiology and therapeutic strategies

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