Microorganisms responsible for periprosthetic knee infections in England and Wales

Holleyman, Richard; Baker, Paul; Charlett, André; Gould, Kate; Deehan, David J.

doi:10.1007/s00167-015-3539-2

Cited by 36 publications

(29 citation statements)

References 22 publications

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“…34 Linkage of the National Joint Registry data to microbiology data could reduce a posteriori any misdiagnoses of prosthetic joint infection, but has been shown to be of limited generalisability, with only 11•8% linkage achievable. 35 The associations that we have identified might vary with different causative pathogens, but unfortunately we do not have the data to explore this concept. Our findings should be considered as conservative estimates of the risk factors with the strongest effects.…”

Section: Discussionmentioning

confidence: 94%

Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales

Lenguerrand

Whitehouse

Beswick

et al. 2019

The Lancet Infectious Diseases

149

155

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Background Prosthetic joint infection is a devastating complication of knee replacement. The risk of developing a prosthetic joint infection is affected by patient, surgical, and health-care system factors. Existing evidence is limited by heterogeneity in populations studied, short follow-up, inadequate power, and does not differentiate early prosthetic joint infection, most likely related to the intervention, from late infection, more likely to occur due to haematogenous bacterial spread. We aimed to assess the overall and time-specific associations of these factors with the risk of revision due to prosthetic joint infection following primary knee replacement. Methods In this cohort study, we analysed primary knee replacements done between 2003 and 2013 in England and Wales and the procedures subsequently revised for prosthetic joint infection between 2003 and 2014. Data were obtained from the National Joint Registry linked to the Hospital Episode Statistics data in England and the Patient Episode Database for Wales. Each primary replacement was followed for a minimum of 12 months until the end of the observation period (Dec 31, 2014) or until the date of revision for prosthetic joint infection, revision for another indication, or death (whichever occurred first). We analysed the data using Poisson and piecewise exponential multilevel models to assess the associations between patient, surgical, and health-care system factors and risk of revision for prosthetic joint infection. Findings Of 679 010 primary knee replacements done between 2003 and 2013 in England and Wales, 3659 were subsequently revised for an indication of prosthetic joint infection between 2003 and 2014, after a median follow-up of 4•6 years (IQR 2•6-6•9). Male sex (rate ratio [RR] for male vs female patients 1•8 [95% CI 1•7-2•0]), younger age (RR for age ≥80 years vs <60 years 0•5 [0•4-0•6]), higher American Society of Anaesthesiologists [ASA] grade (RR for ASA grade 3-5 vs 1, 1•8 [1•6-2•1]), elevated body-mass index (BMI; RR for BMI ≥30 kg/m² vs <25 kg/m² 1•5 [1•3-1•6]), chronic pulmonary disease (RR 1•2 [1•1-1•3]), diabetes (RR 1•4 [1•2-1•5]), liver disease (RR 2•2 [1•6-2•9]), connective tissue and rheumatic diseases (RR 1•5 [1•3-1•7]), peripheral vascular disease (RR 1•4 [1•1-1•7]), surgery for trauma (RR 1•9 [1•4-2•6]), previous septic arthritis (RR 4•9 [2•7-7•6]) or inflammatory arthropathy (RR 1•4 [1•2-1•7]), operation under general anaesthesia (RR 1•1 [1•0-1•2]), requirement for tibial bone graft (RR 2•0 [1•3-2•7]), use of posterior stabilised fixed bearing prostheses (RR for posterior stabilised fixed bearing prostheses vs unconstrained fixed bearing prostheses 1•4 [1•3-1•5]) or constrained condylar prostheses (3•5 [2•5-4•7]) were associated with a higher risk of revision for prosthetic joint infection. However, uncemented total, patellofemoral, or unicondylar knee replacement (RR for uncemented vs cemented total knee replacement 0•7 [95% CI 0•6-0•8], RR for patellofemoral vs cemented total knee replacement 0•3 [0•2-0•5], and RR for unic...

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Section: Discussionmentioning

confidence: 94%

Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales

Lenguerrand

Whitehouse

Beswick

et al. 2019

The Lancet Infectious Diseases

149

155

View full text Add to dashboard Cite

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“…Laboratory data were collected through PHE's 'second generation laboratory surveillance system' (SGSS) which collates information on confirmed pathogens from national and regional laboratories in England [17]. Anonymised laboratory data were collated between period 30 September 2013 to 19 July 2015, (week 40 in 2013 to week 29 in 2015), as weekly counts of respiratory pathogens by specimen date.…”

Section: Laboratory Datamentioning

confidence: 99%

The burden of seasonal respiratory infections on a national telehealth service in England

et al. 2017

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Seasonal respiratory illnesses present a major burden on primary care services. We assessed the burden of respiratory illness on a national telehealth system in England and investigated the potential for providing early warning of respiratory infection. We compared weekly laboratory reports for respiratory pathogens with telehealth calls (NHS 111) between week 40 in 2013 and week 29 in 2015. Multiple linear regression was used to identify which pathogens had a significant association with respiratory calls. Children aged <5 and 5-14 years, and adults over 65 years were modelled separately as were time lags of up to 4 weeks between calls and laboratory specimen dates. Associations with respiratory pathogens explained over 83% of the variation in cold/flu, cough and difficulty breathing calls. Based on the first two seasons available, the greatest burden was associated with respiratory syncytial virus (RSV) and influenza, with associations found in all age bands. The most sensitive signal for influenza was calls for 'cold/flu', whilst for RSV it was calls for cough. The best-fitting models showed calls increasing a week before laboratory specimen dates. Daily surveillance of these calls can provide early warning of seasonal rises in influenza and RSV, contributing to the national respiratory surveillance programme.

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“…The implanted biomaterial must possess broadspectrum antibacterial performance as a wide variety of bacteria can infect an implant, including Gram-positive and Gram-negative bacteria. 39 The implant also needs to exhibit excellent biological properties to promote osseointegration at the bone-implant interface, thereby limiting the chances of infection leading to osteolysis and implant loosening. 34,40 In the present study, we have successfully fabricated Znsurface-modied Ti substrates via PDA chemical surface modication to achieve both excellent biological and antibacterial performance.…”

Section: Discussionmentioning

confidence: 99%

Bi-functional titanium-polydopamine-zinc coatings for infection inhibition and enhanced osseointegration

et al. 2019

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The ideal orthopedic implant coating is expected to both inhibit microbial infection and promote osseointegration. In this study, Zn ions were immobilized on a Ti substrate via a polydopamine (PDA) chemical surface modification to prepare Ti-PDA-Zn coatings. Scanning electron microscopy (SEM), atomic force microscopy (AFM), energy-dispersive X-ray spectroscope (EDS), X-ray photoelectron spectroscopy (XPS), contact analysis system, and inductively coupled plasma atomic emission spectrometry (ICP-AES) were used to analyze the morphology, composition, wettability, and zinc ions release of the coatings. The Ti-PDA-Zn coatings demonstrated excellent antibacterial activities in vitro against both Staphylococcus aureus and Escherichia coli. The coatings additionally displayed good biocompatibility, as confirmed by cytoskeletal observations and cell viability assays. Furthermore, the in vivo results confirmed the excellent antibacterial properties and improved osseointegration capability of the Ti-PDA-Zn coating in the presence of S. aureus. The present findings indicate that the Ti-PDA-Zn coatings prepared herein have potential application in orthopedic implantation.

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Microorganisms responsible for periprosthetic knee infections in England and Wales

Abstract: IV.

Cited by 36 publications

References 22 publications

Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales

Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales

The burden of seasonal respiratory infections on a national telehealth service in England

Bi-functional titanium-polydopamine-zinc coatings for infection inhibition and enhanced osseointegration

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