Analysis of Causative Microorganism in 248 Primary Hip Arthroplasties                     Revised for Infection: A Study Using the NJR Dataset

Holleyman, Richard; Baker, Paul; Charlett, André; Gould, Kate; Deehan, David J.

doi:10.5301/hipint.5000313

Cited by 20 publications

(16 citation statements)

References 27 publications

(40 reference statements)

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“… 33 Linkage of the NJR data to microbiology data could reduce any misdiagnoses of PJI but has proven to be of limited generalisability with 12% NJR linkage achievable. 34 …”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with revision for prosthetic joint infection after hip replacement: a prospective observational cohort study

Lenguerrand

Whitehouse

Beswick

et al. 2018

The Lancet Infectious Diseases

151

104

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SummaryBackgroundThe risk of prosthetic joint infection (PJI) is influenced by patient, surgical, and health-care factors. Existing evidence is based on short-term follow-up. It does not differentiate between factors associated with early onset caused by the primary intervention from those associated with later onset more likely to result from haematogenous spread. We aimed to assess the overall and time-specific associations of these factors with the risk of revision due to PJI after primary total hip replacement.MethodsWe did a prospective observational cohort study analysing 623 253 primary hip procedures performed between April 1, 2003, and Dec 31, 2013, in England and Wales and recorded the number of procedures revised because of PJI. We investigated the associations between risk factors and risk of revision for PJI across the overall follow-up period using Poisson multilevel models. We reinvestigated the associations by post-operative time periods (0–3 months, 3–6 months, 6–12 months, 12–24 months, >24 months) using piece-wise exponential multilevel models with period-specific effects. Data were obtained from the National Joint Registry linked to the Hospital Episode Statistics data.Findings2705 primary procedures were subsequently revised for an indication of PJI between 2003 and 2014, after a median (IQR) follow up of 4·6 years (2·6–7·0). Among the factors associated with an increased revision due to PJI there were male sex (1462 [1·2‰] of 1 237 170 male-years vs 1243 [0·7‰] of 1 849 691 female-years; rate ratio [RR] 1·7 [95% CI 1·6–1·8]), younger age (739 [1·1‰] of 688 000 person-years <60 years vs 242 [0·6‰] of 387 049 person-years ≥80 years; 0·7 [0·6–0·8]), elevated body-mass index (BMI; 941 [1·8‰] 517 278 person-years with a BMI ≥30 kg/m2vs 272 [0·9‰] of 297 686 person-years with a BMI <25 kg/m2; 1·9 [1·7–2·2]), diabetes (245 [1·4‰] 178 381 person-years with diabetes vs 2120 [1·0‰] of 2 209 507 person-years without diabetes; 1·4 [1·2–1·5]), dementia (5 [10·1‰] of 497 person-years with dementia at 3 months vs 311 [2·6‰] of 120 850 person-years without dementia; 3·8 [1·2–7·8]), previous septic arthritis (22 [7·2‰] of 3055 person-years with previous infection vs 2683 [0·9‰] of 3 083 806 person-years without previous infection; 6·7 [4·2–9·8]), fractured neck of femur (66 [1·5‰] of 43 378 person-years operated for a fractured neck of femur vs 2639 [0·9‰] of 3 043 483 person-years without a fractured neck of femur; 1·8 [1·4–2·3]); and use of the lateral surgical approach (1334 [1·0‰] of 1 399 287 person-years for lateral vs 1242 [0·8 ‰] of 1 565 913 person-years for posterior; 1·3 [1·2–1·4]). Use of ceramic rather than metal bearings was associated with a decreased risk of revision for PJI (94 [0·4‰] of 239 512 person-years with ceramic-on-ceramic bearings vs 602 [0·5‰] of 1 114 239 peron-years with metal-on-polyethylene bearings at ≥24 months; RR 0·6 [0·4–0·7]; and 82 [0·4‰] of 190 884 person-years with ceramic-on-polyethyene bearings vs metal-on-polyethylene bearings at ≥24 months; 0·7 [0·5–0·9]). Most of...

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“… 33 Linkage of the NJR data to microbiology data could reduce any misdiagnoses of PJI but has proven to be of limited generalisability with 12% NJR linkage achievable. 34 …”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with revision for prosthetic joint infection after hip replacement: a prospective observational cohort study

Lenguerrand

Whitehouse

Beswick

et al. 2018

The Lancet Infectious Diseases

151

104

View full text Add to dashboard Cite

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“…Prosthetic joint infection (PJI) is a disastrous complication after arthroplasty surgeries which causes great burden to both patients and surgeons, as well as social economy [1–4]. Staphylococcus aureus (S. aureus) is one of the leading causative pathogens of PJI [5–8]. Due to its array of virulence and the ability to form biofilm [7, 9–13], S. aureus -induced PJI is particularly difficult to combat.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial characteristics of Berberine against prosthetic joint infection-related Staphylococcus aureus of different multi-locus sequence types

Tan

Wang

Yang

et al. 2019

BMC Complement Altern Med

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Background Staphylococcal aureus (S. aureus) has become the leading causative pathogen of Prosthetic Joint Infection (PJI), which is the most devastating complication after arthroplasty surgeries. Due to the biofilm formation ability and emergence of multiple-drugs resistance strains of S. aureus , it has become an urgency to find new anti-staphylococcal agents to establish effective prophylaxis and treatment strategy for PJI. Extracted from a traditional Chinese herb, berberine is proved active in inhibiting S. aureus , while whether it exerts the same effect on PJI-related S. aureus remains unknown. This study aims to investigate the antimicrobial activity of berbrine against clinical derived PJI-related S. aureus and whether its inhibiting efficacy is associated with subtypes of S. aureus . Methods Eighteen PJI-associated S. aureus were collected and their Multi-locus Sequence Types (MLST) and susceptibility to berberine both in planktonic and biofilm form were investigated. Additionally, one S. aureus strain (ST1792) was selected from the group and its transcriptomic profiling in berberine incubation was performed. The statistical analyses were conducted using Student’s t-test with SPSS 24.0(SPSS, IBM, USA). The data were expressed as the means ± standard deviation. Values of p < 0.05 were considered statistically significant. Results It was found out that the Minimum Inhibitory Concentration values of PJI-related S. aureus varied in a broad range (from 64 to 512 μg/ml) among different MLST subtypes and the bacteria were able to regain growth after 24 h in berberine of MIC value or higher concentrations. In addition, sub-inhibitory concentrations of berberine surprisingly enhanced biofilm formation in some S. aureus strains. Conclusion Traditional medicine is utilised by a large number of individuals, which provides abundant resources for modern medical science. In our study, berberine was found bactericidal against PJI related S. aureus , however, its antibacterial property was impacted by the MLST subtypes of the bacteria, both in planktonic and biofilm growth forms.

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“…This can be attributed to the small predictive effect of ALBC of erythromycin as evidenced by the 95% confidence intervals in the univariate analysis (Table 4) becoming overwhelmed by the effects of other covariates. The methodological and data linkage limitations associated with the present study have been discussed previously [11, 12]. Unfortunately, the small numbers of cases employing uncemented fixation in the knee arthroplasty cohort precluded meaningful regression analysis of predictors of antibiotic resistance in this group.…”

Section: Discussionmentioning

confidence: 93%

“…Deep periprosthetic infection (PJI) following primary hip and knee arthroplasty is a catastrophic complication in terms of patient outcome and cost to the health service. The implicated microorganism(s) are important determinants of clinical outcome and previous work by our group has described the epidemiology in England and Wales by linking data held by the national joint registry (NJR) to national microbiology data [11, 12].…”

Section: Introductionmentioning

confidence: 99%

Staphylococcal resistance profiles in deep infection following primary hip and knee arthroplasty: a study using the NJR dataset

Holleyman

Deehan

Walker

et al. 2019

Arch Orthop Trauma Surg

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Introduction This study aimed to (1) report the rates of resistance against a variety of antibiotics for pure Staphylococcal infections, and (2) examine the impact of ALBC use at primary surgery has on resistance patterns for patients undergoing first-time revision of primary hip and knee arthroplasty for indication of infection. Materials and methods Data from the National Joint Registry database for England and Wales were linked to microbiology data held by Public Health England to identify a consecutive series of 258 primary hip and knee arthroplasties performed between April 2003 and January 2014 that went on to have a revision for Staphylococcal deep periprosthetic infection. Multivariate binary logistic regression was used to study predictors of microorganism resistance to a range of antimicrobials. Results After adjusting for patient and surgical factors, multivariate analysis showed the use of gentamicin-loaded bone cement at the primary surgery was associated with a significant increase in the risk of Staphylococcal gentamicin resistance (odds ratio 8.341, 95% CI 2.297–30.292, p = 0.001) and methicillin resistance (odds ratio 3.870, 95% CI 1.319–11.359, p = 0.014) at revision for infection. Conclusions Clinicians must anticipate the possibility of antibiotic resistance to ALBC utilised at primary surgery.

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Analysis of Causative Microorganism in 248 Primary Hip Arthroplasties Revised for Infection: A Study Using the NJR Dataset

Abstract: Both prophylactic and therapeutic antibiotic regimes should be focused on targeting Staphylococci.

Cited by 20 publications

References 27 publications

Risk factors associated with revision for prosthetic joint infection after hip replacement: a prospective observational cohort study

Risk factors associated with revision for prosthetic joint infection after hip replacement: a prospective observational cohort study

Antimicrobial characteristics of Berberine against prosthetic joint infection-related Staphylococcus aureus of different multi-locus sequence types

Staphylococcal resistance profiles in deep infection following primary hip and knee arthroplasty: a study using the NJR dataset

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