Association of Cutibacterium avidum Colonization in the Groin With Obesity: A Potential Risk Factor for Hip Periprosthetic Joint Infection

Böni, Laura; Kuster, Stefan P.; Bartik, Bianka; Zbinden, Reinhard; Zingg, Patrick O.; Achermann, Yvonne

doi:10.1093/cid/ciy379

Cited by 10 publications

(17 citation statements)

References 29 publications

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“…The concept of abundant colonization with multiple microorganisms in the hip region [14, 15] is expected to mainly apply to direct anterior incisions, as previously described in literature [19, 20]. Interestingly, in our cohort obese patients showed abundant colonization with multiple microorganisms as well, even though posterolateral incisions were used for implantation of the hip arthroplasties.…”

Section: Discussionmentioning

confidence: 57%

“…Thirdly, the applied cefazolin dosage as antibiotic prophylaxis may not be sufficient to achieve adequate tissue concentrations in obese patients, especially in patients weighing more than 120kg or with a BMI >40kg/m 2 [11–13]. Finally, obese patients have increased bacterial colonization of the skin compared with non-obese patients, particularly in the groin [14, 15]. Currently applied antibiotic prophylaxis may not provide full coverage for these microorganisms.…”

Section: Introductionmentioning

confidence: 99%

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Obese patients have higher rates of polymicrobial and Gram-negative early periprosthetic joint infections of the hip than non-obese patients

et al. 2019

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Background Obese patients are more likely to develop periprosthetic joint infection (PJI) after primary total joint arthroplasty. This study compared the clinical and microbiological characteristics of non-obese, obese and severely obese patients with early PJI, in order to ultimately optimize antibiotic prophylaxis and other prevention measures for this specific patient category. Methods We retrospectively evaluated patients with early PJI of the hip and knee treated with debridement, antibiotics and implant retention (DAIR) between 2006 and 2016 in three Dutch hospitals. Only patients with primary arthroplasties indicated for osteoarthritis were included. Early PJI was defined as an infection that developed within 90 days after index surgery. Obesity was defined as a BMI ≥30kg/m 2 and severe obesity as a BMI ≥35kg/m 2 . Results A total of 237 patients were analyzed, including 64 obese patients (27.0%) and 62 severely obese patients (26.2%). Compared with non-obese patients, obese patients had higher rates of polymicrobial infections (60.3% vs 33.3%, p<0.001) with more often involvement of Enterococcus species (27.0% vs 11.7%, p = 0.003). Moreover, severely obese patients had more Gram-negative infections, especially with Proteus species (12.9% vs 2.3%, p = 0.001). These results were only found in periprosthetic hip infections, comprising Gram-negative PJIs in 34.2% of severely obese patients compared with 24.7% in obese patients and 12.7% in non-obese patients (p = 0.018). Conclusions Our results demonstrate that obese patients with early periprosthetic hip infections have higher rates of polymicrobial infections with enterococci and Gram-negative rods, which stresses the importance of improving preventive strategies in this specific patient category, by adjusting antibiotic prophylaxis regimens, improving disinfection strategies and optimizing postoperative wound care.

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Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Obese patients have higher rates of polymicrobial and Gram-negative early periprosthetic joint infections of the hip than non-obese patients

et al. 2019

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“…Nowadays, attention has been directed toward a plausible link between PJI and patients’ individual risk factors in addition to the surgical- and hospital-related factors. More recently, substantial studies regarding the patient-related risk factors for PJI, such as obesity [ 4 , 11 – 14 ], diabetes mellitus (DM) [ 14 – 17 ], male gender [ 18 ], rheumatoid arthritis (RA) [ 19 , 20 ], and pulmonary diseases [ 6 , 21 ], have been reported. However, the power of these studies may be impaired due to limited numbers of recruited patients, controversial results and range of potential risk factor studies.…”

Section: Introductionmentioning

confidence: 99%

Patients’ risk factors for periprosthetic joint infection in primary total hip arthroplasty: a meta-analysis of 40 studies

Ren

Lin

et al. 2021

BMC Musculoskelet Disord

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Background Periprosthetic joint infection (PJI) is a catastrophic complication after total hip arthroplasty (THA). Our meta-analysis aimed to identify the individual-related risk factors that predispose patients to PJI following primary THA. Methods Comprehensive literature retrieval from Pubmed, Web of Science, and the Cochrane Library was performed from inception to Feb 20th, 2021. Patient-related risk factors were compared as per the modifiable factors (BMI, smoke and alcohol abuse), non-modifiable factors (gender, age), and medical history characteristics, such as diabetes mellitus (DM), avascular necrosis (AVN) of femoral head, femoral neck fracture, rheumatoid arthritis (RA), cardiovascular disease (CVD), and osteoarthritis (OA) etc. The meta-analysis was applied by using risk ratios with 95% corresponding intervals. Sensitivity analysis and publication bias were performed to further assess the credibility of the results. Results Overall, 40 studies with 3,561,446 hips were enrolled in our study. By implementing cumulative meta-analysis, higher BMI was found associated with markedly increased PJI risk after primary THA [2.40 (2.01–2.85)]. Meanwhile, medical characteristics including DM [1.64 (1.25–2.21)], AVN [1.65 (1.07–2.56)], femoral neck fracture [1.75 (1.39–2.20)], RA [1.37 (1.23–1.54)], CVD [1.34 (1.03–1.74)], chronic pulmonary disease (CPD) [1.22 (1.08–1.37)], neurological disease [1.19 (1.05–1.35)], opioid use [1.53 (1.35–1.73)] and iron-deficiency anemia (IDA) [1.15 (1.13–1.17)] were also significantly correlated with higher rate of PJI. Conversely, dysplasia or dislocation [0.65 (0.45–0.93)], and OA [0.70 (0.62–0.79)] were protective factors. Of Note, female gender was protective for PJI only after longer follow-up. Besides, age, smoking, alcohol abuse, previous joint surgery, renal disease, hypertension, cancer, steroid use and liver disease were not closely related with PJI risk. Conclusion Our finding suggested that the individual-related risk factors for PJI after primary THA included high BMI, DM, AVN, femoral neck fracture, RA, CVD, CPD, neurological disease, opioid use and IDA, while protective factors were female gender, dysplasia/ dislocation and OA.

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“…Consistent with previous finding [27,18], our data showed that patients with a BMI greater than 40, 35, o r 30 had a 3.64, 2.46, or 2.02-fo ld higher risk of PJI co mpared with those counterparts with less BMI, respectively. Obese patients are more prone to increased risk of PJI in the peri-operative setting, which may be attributed to prolonged operative and anesthetic time, higher risk of colonizat ion for C. avidum in the groin [11], longer hospital stay and high readmission rates within 30 days [9]. Besides, being obese is usually correlated with higher presence of other commod ities including metabolic syndrome, wound dehiscence, and heart disease [1].…”

Section: Discussionmentioning

confidence: 99%

Patients' risk factors for periprosthetic joint infection in total hip arthroplasty: A systematic review and meta-analysis of 34 studies

Ren

Zhang

et al. 2020

Preprint

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BackgroundPeriprosthetic joint infection (PJI) is a catastrophic complication following total hip arthroplasty (THA). This meta-analysis aimed to identify the individual-related risk factors that predispose patients to PJI undergoing THA.MethodsWe performed extensive literature retrieval from related databases from inception to October 20, 2019. Patient-related risk factors were compared and grouped according to modifiable factors (BMI, smoke and alcohol abuse), non- modifiable factors (gender, age), and medical history characteristics, such as diabetes mellitus (DM), avascular necrosis (AVN) of femoral head, femoral neck fracture, rheumatoid arthritis (RA), cardiovascular disease (CVD), and osteoarthritis (OA) etc. Meta-analysis was performed using risk ratios with 95% corresponding intervals. Sensitivity analysis and publication bias were performed to assess the credibility of the results.ResultsOverall, 34 studies with 2,141,960 hips were included. By implementing cumulative meta-analysis, we found that higher BMI significantly increased the rate of PJI after THA. Meanwhile, medical characteristics comprising DM, AVN, femoral neck fracture, RA, CVD, chronic pulmonary disease and neurological disease, were also markedly associated with higher PJI risk. Conversely, dysplasia or dislocation, and OA were protective factors. Notably, female gender was protective for PJI only after longer follow-up. Besides, age, smoking, alcohol abuse, previous joint surgery, renal disease, hypertension, cancer and steroid use were not correlated with risk of PJI.ConclusionOur finding indicates that the main risk factors for PJI are high BMI, DM, AVN, femoral neck fracture, RA, CVD, chronic pulmonary disease, and neurological disease. Protective factors are female gender, dysplasia/ dislocation and OA.

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Association of Cutibacterium avidum Colonization in the Groin With Obesity: A Potential Risk Factor for Hip Periprosthetic Joint Infection

Abstract: The groin, rather than the anterior thigh, showed colonization for C. avidum in obese patients. Further studies are needed to evaluate current skin disinfection and draping protocols for hip arthroplasty, particularly in obese patients.

Cited by 10 publications

References 29 publications

Obese patients have higher rates of polymicrobial and Gram-negative early periprosthetic joint infections of the hip than non-obese patients

Obese patients have higher rates of polymicrobial and Gram-negative early periprosthetic joint infections of the hip than non-obese patients

Patients’ risk factors for periprosthetic joint infection in primary total hip arthroplasty: a meta-analysis of 40 studies

Patients' risk factors for periprosthetic joint infection in total hip arthroplasty: A systematic review and meta-analysis of 34 studies

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