Burden of Staphylococcus aureus infections after orthopedic surgery in Germany

Abstract

Background: This study assessed incidence, risk factors, and outcomes of Staphylococcus aureus infections (SAI) following endoprosthetic hip or knee, or spine surgeries. Methods: Adult patients with at least one of the selected surgeries from 2012 to 2015 captured in a German sickness fund database were included. SAI were identified using S. aureus-specific ICD-10 codes. Patients with certain prior surgeries and infections were excluded. Cumulative incidence and incidence density of post-surgical SAI were assessed. Risk factors, mortality, healthcare resource utilization and direct costs were compared between SAI and non-SAI groups using multivariable analyses over the 1 year follow-up. Results: Overall, 74,327 patients who underwent a knee (28.6%), hip (39.6%), or spine surgery (31.8%) were included. The majority were female (61.58%), with a mean age of 69.59 years and a mean Charlson Comorbidity Index (CCI) of 2.3. Overall, 1.92% of observed patients (20.20 SAI per 1000 person-years (PY)) experienced a SAI within 1 year of index hospitalization. Knee surgeries were associated with lower SAI risk compared with hip surgeries (Hazard Ratio (HR) = 0.8; p = 0.024), whereas spine surgeries did not differ significantly from hip surgeries. Compared with non-SAI group, the SAI group had on average 4.4 times the number of hospitalizations (3.1 vs. 0.7) and 7.7 times the number of hospital days (53.5 vs. 6.9) excluding the index hospitalization (p < 0.001). One year post-orthopedic mortality was 22.38% in the SAI and 5.31% in the non-SAI group (p < 0.001). The total medical costs were significantly higher in the SAI group compared to non-SAI group (42,834€ vs. 13,781€; p < 0.001). Adjusting for confounders, the SAI group had nearly 2 times the all-cause direct healthcare costs (exp(b) = 1.9; p < 0.001); and 1.72 times higher risk of death (HR = 1.72; p < 0.001). Conclusions: SAI risk after orthopedic surgeries persists and is associated with significant economic burden and risk of mortality. Hence, risk reduction and prevention methods are of utmost importance.

Design, Characterization, and Antibacterial Performance of MAPLE-Deposited Coatings of Magnesium Phosphate-Containing Silver Nanoparticles in Biocompatible Concentrations

“…Orthopedic surgery is often complicated by the occurrence of post-operative infections produced by S. aureus , other Gram-positive organisms, Gram-negative organisms including P. aeruginosa, and fungal infections, which, due to their high frequency and antimicrobial resistance features are associated with increased morbidity and mortality, decreased quality of life, and higher hospitalization costs [ 65 , 66 , 67 ]. Despite the huge technological and medical progress, the incidence of implant-associated infections is increasing proportionally to the number of patients needing implant devices [ 68 ].…”

Influence of chitosan and chitosan oligosaccharide on dual antibiotic-loaded bone cement: In vitro evaluations

“…S . aureus [ 15 , 16 ] and MRSA [ 17 – 19 ] are the most common pathogen in orthopaedic surgical site infections. The antimicrobial activity of bone cement specimens was tested against S .…”

“…S. aureus [15,16] and MRSA [17][18][19] are the most common pathogen in orthopaedic surgical site infections. The antimicrobial activity of bone cement specimens was tested against S. aureus and MRSA using supernatant obtained from the drug elution assay at the end of the experiment (day 7).…”

Real-world treatment of German patients with recurrent and advanced endometrial cancer with a post-platinum treatment: a retrospective claims data analysis

“…Furthermore, information on disease stage and treatment lines could only be derived by proxies. Finally, by using only data from one regional German sickness fund, the results might not be fully representative of the whole German population, although treatment patterns and reimbursement rules for statutory health insurances are comparable across Germany (Ghiani et al 2022 ; Hardtstock et al 2020a , b ).…”