Burden of Surgical Site Infections Associated with Arthroplasty and the Contribution of<i>Staphylococcus aureus</i>

Patel, Harshila; Khoury, Hanane; Girgenti, Douglas; Welner, Sharon A.; Yu, Holly

doi:10.1089/sur.2014.246

Cited by 35 publications

(28 citation statements)

References 92 publications

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“…This is in line with previous observations in Germany, reporting considerable differences in the length of stay between infected and non-infected patients [28,29]. Compared with previous studies in the United States [3,30,31], our hospitalization day results are higher. This reflects differences in the health care practice and reimbursement systems of both states which also account for a longer length of stays in the hospitals in Germany compared to the United States [32].…”

Section: Discussionsupporting

confidence: 92%

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Burden of Staphylococcus aureus infections after orthopedic surgery in Germany

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 92%

“…Our results showed overall unadjusted cost ratio within 365 days after index orthopedic surgery of 3.1 among SAI compared with non-SAI patients (p < 0.001). A slightly higher cost ratio (3.7) was seen in patients who underwent knee arthroplasty in a German hospital setting and experience/ did not experience any SSI [29,30].…”

Section: Discussionmentioning

confidence: 91%

Burden of Staphylococcus aureus infections after orthopedic surgery in Germany

et al. 2020

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“…Across the globe, SSIs are associated with increased morbidity and mortality; sequelae include revision surgeries, poor quality of life, prolonged antibiotic treatment and rehabilitation, and associated lost work and productivity (Control ECfDPa, 2015;Suaya et al, 2014;Tanner et al, 2013;Moore et al, 2015;Gelhorn and Parvizi et al, 2016;Kuhns et al, 2015). Moreover, SSIs are associated with a substantial economic burden to the healthcare system as a result of increased length of hospital stay and increased risk of readmission (Patel et al, 2016(Patel et al, , 2017. Although estimates vary, medical costs have been projected to be between $15 800 and $43 900 per SSI (Kaye et al, 2009;McGirt et al, 2011;Weber et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Surgical site infection in elective clean and clean-contaminated surgeries in developing countries

Curcio

Cané

Fernández³

et al. 2019

International Journal of Infectious Diseases

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Background: Surgical site infection (SSI) is both the most frequently studied healthcare-associated infection and the most common healthcare-associated infection in the developing world. A systematic review and meta-analysis was conducted to evaluate the relative size of this burden and to estimate the prevalence of SSI in clean and clean-contaminated surgeries in a large sample of countries in the developing world. Methods: A systematic search of the MEDLINE/PubMed, Scopus, and LILACS databases was conducted to identify studies providing the prevalence of SSI in elective clean and clean-contaminated surgeries in 39 countries or regions around the world. Data of interest were limited to publications from January 2000 to December 2017. Studies with information on the number of cases of SSI and number of total elective clean and clean-contaminated surgeries during the same period were included in this evaluation. Studies lacking clear definition of the total number of exposed patients were excluded. Results: Based on the combined data from the 99 articles evaluated in this analysis, the overall prevalence of SSI in elective clean and clean-contaminated surgeries was estimated to be 6% (95% confidence interval (CI) 5-7%). This increased to 15% (95% CI 6-27%) when considering only those reports with post-discharge surveillance data. The overall prevalence of SSI in Africa/Middle East, Latin America, Asia, and China was 10% (95% CI 6-15%), 7% (95% CI 5-10%), 4% (95% CI 4-5%), and 4% (95% CI 2-6%), respectively. Significant variability in the data was confirmed by both the funnel plot and the Egger test (p = 0.008). Conclusions: Although the data are variable, it is clear that the incidence of SSI in the developing world is higher than that in the developed world.

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“…Costs are even higher for cases of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) as opposed to other pathogens. [5][6][7][8] The last HAI Prevalence Survey, performed in 2011, estimated that about 150.000 SSIs occurred in U.S. acute care hospitals. 9 Accordingly, data of the last Point Prevalence Survey for HAI, promoted by the European Centre for Disease Prevention and Control (ECDC), in 2011-2012, showed that SSIs represent the 20% of HAI (16% in Italy) (http:// ecdc.europa.eu/en/healthtopics/Healthcare-associated_ infections/database/Pages/hai-pps-database-distribution-HAI-types.aspx).…”

Section: Surgical Site Infections (Ssis) Overviewmentioning

confidence: 99%

The role of dalbavancin in the multi-disciplinary management of wound infections in orthopaedic surgery

Arena

Romanini

Rosi

et al. 2017

Journal of Chemotherapy

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Antimicrobial resistance is continuously increasing among bacterial clinical isolates (especially methicillin resistance in Staphylococcus aureus, MRSA), negatively impacting on outcomes of patients with Surgical Site Infections (SSIs). A multi-disciplinary team work is essential for SSIs prevention and for the choice of antibiotic therapy of orthopaedic SSIs. In particular, an Antibiotic Stewardship (AS) approach is recommended for preserving the activity of old and new antimicrobials. Dalbavancin is a novel antimicrobial agent, belonging to the lipoglycopeptides family, recently approved by FDA for the treatment of ABSSSIs (Acute Bacterial Skin and Skin Structure Infections) and can be considered as a candidate for the treatment of orthopaedic superficial SSIs. An antimicrobial activity directed against MRSA and other multi-resistant Gram-positive pathogens, a bactericidal effect and an extremely extended half-life are among key features of this drug. Dalbavancin gives to clinicians the option to provide an intravenous antimicrobial agent shown to be as effective as conventional therapies, without requiring prolonged admission into the hospital, drastically reducing the length of hospital stay (without reducing the treatment compliance) and total cost per patient. In this paper, we analyze general, microbiological and pharmacological features of dalbavancin, aiming at supporting clinicians while positioning this drug in the context of orthopaedic SSIs.

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Burden of Surgical Site Infections Associated with Arthroplasty and the Contribution ofStaphylococcus aureus

Cited by 35 publications

References 92 publications

Burden of Staphylococcus aureus infections after orthopedic surgery in Germany

Burden of Staphylococcus aureus infections after orthopedic surgery in Germany

Surgical site infection in elective clean and clean-contaminated surgeries in developing countries

The role of dalbavancin in the multi-disciplinary management of wound infections in orthopaedic surgery

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