Inhaled Corticosteroids, Vitamin K Antagonists and Amlodipine Were Associated with an Increased Risk of Acute Periprosthetic Joint Infection in Patients with Total Hip Arthroplasty: A Retrospective Case–Cohort Study

Abstract

The perioperative use of certain medication may influence the risk of developing a periprosthetic joint infection (PJI). Inhaled corticosteroids (ICSs) and cardiovascular drugs are widely used against pulmonary and cardiovascular diseases. While oral corticosteroids and anticoagulants have been shown to increase the risk of developing PJI, this is not clear for ICSs. In contrast, some cardiovascular drugs, such as amlodipine, nifedipine and statins, have been documented to show an antimicrobial effect, suggesting a synergistic effect with antibiotics in the treatment of (multi-resistant) microorganisms. We performed a case–cohort study to assess the association between the occurrence of PJI after THA and the use of inhaled corticosteroids, anticoagulants, or previously mentioned cardiovascular agents. In a cohort of 5512 primary THAs, we identified 75 patients with a PJI (1.4%), and randomly selected 302 controls. A weighted Cox proportional hazard regression model was used for the study design and to adjust for potential confounders (age, sex, smoking, and cardiovascular/pulmonary disease). We found ICS use (HR 2.6 [95% CI 1.1–5.9]), vitamin K antagonist use (HR 5.3 [95% CI 2.5–11]), and amlodipine use (HR 3.1 [95% CI 1.4–6.9]) to be associated with an increased risk of developing PJI after THA. The effect remained after correction for the mentioned possible confounders. The underlying diseases for which the medications are prescribed could also play a role in the mentioned association; we believe, however, that the usages of ICSs, vitamin K antagonists and amlodipine appear to be potential modifiable risk factors for PJI, and therefore have to be questioned during preoperative screening and consultation.

Preoperative Risk Factors for Periprosthetic Joint Infection: A Narrative Review of the Literature

“…Kumar et al [85] and Yi et al [86] found that amlodipine inhibits a variety of bacteria both in vitro and in vivo in animal models, but this effect has not been tested in humans. In contrast to previous in vitro and animal studies, Bruin et al [83] found an increased risk of PJI in patients taking amlodipine. In conclusion, even if a correlation between CSI, VKAs, amlodipine, and the development of PJI is found, it could be determined by the association of the clinical picture and underlying diseases for which these drugs were prescribed.…”

“…Bruin et al examined a sample of 5512 patients, of whom 75 developed PJI. Among them, 10 (13%) used ICS perioperatively, 16 (21%) used VKA preoperatively, and 11 (15%) used amlodipine perioperatively [ 83 ].…”

Evaluation of Comorbidities as Risk Factors for Fracture-Related Infection and Periprosthetic Joint Infection in Germany

“…For FRI, as well, an increased risk with a higher rate of diabetes ( p = 0.050) in cases with postoperative infection was detected [ 26 ]. Additionally, the intake of various drugs such as inhaled corticosteroids (hazards ratio (HR): 2.6), amlodipine (HR: 3.1) and vitamin K antagonists (HR: 5.3) were associated with an increased infection risk after hip arthroplasty [ 16 ].…”

“…In PJI, Namba et al (2012) detected an increased rate of patients with diabetes and a higher rate of ASA (American Society of Anesthesiologists) scores [ 14 ]. Additionally, the intake of various drugs modifying the immune system and coagulation were reported with increased infection risk [ 16 ].…”

Laponite intercalated biomimetic multilayer coating prevents glucocorticoids induced orthopedic implant failure

“…Glucocorticoids (GCs) are immunosuppressive agents commonly used for autoimmune and inflammatory diseases, such as asthma, systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA) [ 7 ]. Patients receiving long-term GCs therapy experience rapid bone loss and an increased risk of infection, which results in an almost 1.5–2.5-fold increased request of revision surgery in these patients after primary surgical treatment [ [8] , [9] , [10] ]. However, few previous studies have drawn up the strategies to prevent implant failure in GCs-treated patients; therefore, novel therapeutic approaches are needed to prevent implant failure in these patients.…”