Economic Burden of Periprosthetic Joint Infection in the United States

Kurtz, Steven M.; Lau, Edmund; Watson, Heather; Schmier, Jordana K.; Parvızı, Javad

doi:10.1016/j.arth.2012.02.022

Cited by 1,413 publications

(953 citation statements)

References 20 publications

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“…However, when stratifying our patients by NHSN classification, we did not find a reduction in the risk of developing an infection. An effective chlorhexidine cloth protocol could reduce the periprosthetic infection rate in this patient population, which is projected to increase dramatically in the near future [19]. By minimizing these infection rates, we can help reduce the economic burden to the patients, institutions, and overall healthcare system as well as the risks of marked morbidity and mortality associated with these infections.…”

Section: Discussionmentioning

confidence: 99%

Does Preadmission Cutaneous Chlorhexidine Preparation Reduce Surgical Site Infections After Total Hip Arthroplasty?

Kapadia

Jauregui

Murray

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Periprosthetic hip infections are among the most catastrophic complications after total hip arthroplasty (THA). We had previously proven that the use of chlorhexidine cloths before surgery may help decrease these infections; hence, we increased the size of the previously reported cohort. Questions/purposes (1) Does a preadmission chlorhexidine cloth skin preparation protocol decrease the risk of surgical site infection in patients undergoing THA? (2) When stratified using the National Healthcare Safety Network (NHSN) risk categories, which categories are associated with risk reduction from the preadmission chlorhexidine preparation protocol? Methods Between 2007 and 2013, a group of 998 patients used chlorhexidine cloths before surgery, whereas a group of 2846 patients did not use them and underwent standard perioperative disinfection only. Patient records were reviewed to determine the development of periprosthetic infection in both groups of patients. Results Patients without the preoperative chlorhexidine gluconate disinfection protocol had a higher risk of infections (infections with protocol: six of 995 [0.6%]; infections in control: 46 of 2846 [1.62%]; relative risk: 2.68 [95% confidence interval {CI}, 1.15-0.26]; p = 0.0226). When stratified based on risk category, no differences were detected; preadmission chlorhexidine preparation was not associated with reduced infection risk for low, medium, and high NHSN risk categories (p = 0.386, 0.153, and 0.196, respectively). Conclusions The results of our study suggest that this cloth application appears to reduce the risk of infection in patients undergoing THA. When stratified by risk categories, we found no difference in the infection rate, but these findings were underpowered. Although future multicenter randomized trials will need to confirm these preliminary findings, the intervention is inexpensive and is unlikely to be risky and so might be considered on the basis of this retrospective, comparative study. Level of Evidence Level III, therapeutic study.

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Section: Discussionmentioning

confidence: 99%

Does Preadmission Cutaneous Chlorhexidine Preparation Reduce Surgical Site Infections After Total Hip Arthroplasty?

Kapadia

Jauregui

Murray

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Considering periprosthetic joint infection alone, the annual cost of infected revisions to U.S. hospitals is projected to exceed $1.62 billion by 2020. 1 The mainstay of treatment has been the use of systemic and localized antibiotics. However, bacteria responsible for these infections continue to evolve resistance to commonly used antibiotics (i.e., methicillin) 2 and clearance of polymicrobial infection in patients can be difficult to achieve.…”

Section: Introductionmentioning

confidence: 99%

Comparing PMMA and calcium sulfate as carriers for the local delivery of antibiotics to infected surgical sites

McConoughey

Howlin

Wiseman

et al. 2014

J. Biomed. Mater. Res.

102

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Antibiotic-loaded bone cement is a primary option for treatment of orthopedic infections. Poly(methyl methacrylate) (PMMA) is a widely used cement that, when loaded with antibiotics in spacer or bead form, has been shown to reduce infection rates. However, PMMA is not resorbable and requires a second surgery for removal, while also acting as a potential foreign body for bacterial colonization. Alternatively, resorbable bone cements, such as calcium sulfate, have been proposed and present the advantage of being completely reabsorbed. It is unknown whether the antibiotic elution characteristics of absorbable bone cements are similar to PMMA. This study (1) characterized antibiotic elution from synthetic, highly purified calcium sulfate cement beads of varying sizes against pathogenic bacteria both in liquid culture and seeded on agar plates, (2) tested calcium sulfate beads against PMMA beads loaded with the same antibiotics, and (3) analyzed the structural differences between how PMMA and calcium sulfate bind to antibiotics. In every assay, the calcium sulfate beads performed as well as, or better than, the PMMA beads in inhibition of bacterial growth and elution of vancomycin in vitro with complete elution observed from calcium sulfate within three days. These data suggest that calcium sulfate, functions, as well as PMMA in the patient setting for infection control.

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“…Five to ten percent of joint replacements are revised within seven years [2] with prosthetic joint infection (PJI) being one of the most common reasons for revision [3]. PJI is an increasing healthcare burden [4] with a recurrence rate of 16 % [5]) and a mortality rate of 2.5 % [6]. End-stage treatments are severely morbid, including multiple revisions, resection arthroplasty, arthrodesis and amputation [7].…”

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confidence: 99%

A fully functional drug-eluting joint implant

et al. 2017

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Despite advances in orthopedic materials, the development of drug-eluting bone and joint implants that can sustain the delivery of the drug and maintain the necessary mechanical strength in order to withstand loading has remained elusive. Here, we demonstrate that modifying the eccentricity of drug clusters and the percolation threshold in ultrahigh molecular weight polyethylene (UHMWPE) results in maximized drug elution and in the retention of mechanical strength. The optimized UHMWPE eluted antibiotic at a higher concentration for longer than the clinical gold standard antibiotic-eluting bone cement while retaining the mechanical and wear properties of clinically used UHMWPE joint prostheses. Treatment of lapine knees infected with Staphylococcus aureus with the antibiotic-eluting UHMWPE led to complete bacterial eradication and to the absence of detectable systemic effects. We argue that the antibiotic-eluting UHMWPE joint implant is a promising candidate for clinical trials.

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Economic Burden of Periprosthetic Joint Infection in the United States

Cited by 1,413 publications

References 20 publications

Does Preadmission Cutaneous Chlorhexidine Preparation Reduce Surgical Site Infections After Total Hip Arthroplasty?

Does Preadmission Cutaneous Chlorhexidine Preparation Reduce Surgical Site Infections After Total Hip Arthroplasty?

Comparing PMMA and calcium sulfate as carriers for the local delivery of antibiotics to infected surgical sites

A fully functional drug-eluting joint implant

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