Postoperative deep infection in tumor endoprosthesis reconstruction around the knee

Morii, Takeshi; Yabe, Hiroo; Morioka, Hideo; Beppu, Yasuo; Chuman, Hirokazu; Kawai, Akira; Takeda, Ken; Kikuta, Kazutaka; Hosaka, Seiichi; Yazawa, Yasuo; Takeuchi, Katsuhito; Anazawa, Ukei; Mochizuki, Kazuo; Satomi, Kazuhiko

doi:10.1007/s00776-010-1467-z

Cited by 39 publications

(63 citation statements)

References 13 publications

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“…In a systematic review of patients with primary bony malignant tumors treated with endoprosthetic reconstruction, the overall infection rate was reported as 10% [4], whereas Jeys et al [6] reported an overall rate of 11%. In another study specifically confined to endoprosthesis around the knee, a higher rate of 17% was observed [7].…”

Section: Discussionmentioning

confidence: 91%

“…Deep infection was diagnosed based on the U.S. Centers for Disease Control and Prevention (CDC) guidelines [12] with the following modifications: Organ-space infections and deep incisional infections were managed together as ''deep infections'' and infections occurring more than 12 mo after the initial tumor endoprosthesis operation were also considered [6,7,11]. All tissue samples for microbiologic cultures were taken intra-operatively and were obtained close to the surface of the prosthesis and from contiguous inflamed tissue.…”

Section: Definitionmentioning

confidence: 99%

“…Although the benefits are indisputable, implantation of these prostheses carries the risk of various complications such as infection, structural breakage, soft tissue failure, and aseptic loosening, which may ultimately result in implant failure [2,5]. Deep infection (e.g., deep incisional surgical site infection) remains one of the most devastating complications in endoprosthetic reconstruction, with reported rates ranging from 10% to 17% [2,4,6,7]. The lengthy and complex operations compounded with the immunocompromised status of patients favor the higher rates [4,6].…”

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confidence: 99%

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Deep Infections after Endoprosthetic Replacement Operations in Orthopedic Oncology Patients

Dhanoa

Singh

Elbahri³

2015

Surgical Infections

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Patients undergoing endoprosthetic replacement for various orthopedic oncologic conditions have high infection rates. The present study allows early identification of such patients in view of the high morbidity associated with this condition. This report also highlights the high rate of multi-drug-resistant infections, especially methicillin-resistant strains of S. aureus and CoNS encountered, which complicates further the management of these patients.

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Section: Discussionmentioning

confidence: 91%

Section: Definitionmentioning

confidence: 99%

mentioning

confidence: 99%

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Deep Infections after Endoprosthetic Replacement Operations in Orthopedic Oncology Patients

Dhanoa

Singh

Elbahri³

2015

Surgical Infections

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“…The I 2 statistic, representing the percentage of total variation across studies owing to heterogeneity, was found to be moderate at 54.2% (95% CI, 33.3%-66.4%). Thirteen studies further specified the organism associated with infection [20,21,23,24,30,31,33,37,40,44,52,55,57]. The most common causative organisms were Staphylococcus aureus and coagulase-negative staphylococci, such as S. epidermis, all of which are Gram-positive.…”

Section: Resultsmentioning

confidence: 99%

“…The patient also must have purulent drainage, an organism-positive fluid or tissue culture, an abscess, or any other evidence of infection on direct examination or by histopathologic or radiographic measures [27]. Only two studies defined infection according to the CDC; however, neither study limited infection to 1 year after surgery [24,44]. For the remainder of the studies, efforts were made to separate deep infection from superficial infection, where distinctions were made.…”

Section: Discussionmentioning

confidence: 99%

High Infection Rate Outcomes in Long-bone Tumor Surgery with Endoprosthetic Reconstruction in Adults: A Systematic Review

Racano

Pazionis

Farrokhyar

et al. 2013

Clinical Orthopaedics &Amp; Related Research

119

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Background Limb salvage surgery (LSS) with endoprosthetic replacement is the most common method of reconstruction following bone tumor resection in the adult population. The risk of a postoperative infection developing is high when compared with conventional arthroplasty and there are no appropriate guidelines for antibiotic prophylaxis. Questions/purposes We sought to answer the following questions: (1) What is the overall risk of deep infection and the causative organism in lower-extremity long-bone tumor surgery with endoprosthetic reconstruction? (2) What antibiotic regimens are used with endoprosthetic reconstruction? (3) Is there a correlation between infection and either duration of postoperative antibiotics or sample size? Methods We conducted a systematic review of the literature for clinical studies that reported infection rates in adults with primary bony malignancies of the lower extremity treated with surgery and endoprosthetic reconstruction. The search included articles published in English between 1980 and July 2011. Results The systematic literature review yielded 48 studies reporting on a total of 4838 patients. The overall pooled weighted infection rate for lower-extremity LSS with endoprosthetic reconstruction was approximately 10% (95% CI, 8%-11%), with the most common causative organism reported to be Gram-positive bacteria in the majority of cases. The pooled weighted infection rate was 13% after short-term postoperative antibiotics and 8% after long-term postoperative antibiotics. There was no correlation between sample size and infection rate. Conclusions Infection rates of 10% are high when compared with rates for conventional arthroplasty. Our results suggest that long-term antibiotic prophylaxis decreases the risk of deep infection. However, the data should be interpreted with caution owing to the retrospective nature of the studies.

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Comparison of Prophylactic Intravenous Antibiotic Regimens After Endoprosthetic Reconstruction for Lower Extremity Bone Tumors

et al. 2022

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IMPORTANCEThe use of perioperative, prophylactic, intravenous antibiotics is standard practice to reduce the risk of surgical site infection after oncologic resection and complex endoprosthetic reconstruction for lower extremity bone tumors. However, evidence guiding the duration of prophylactic treatment remains limited.OBJECTIVE To assess the effect of a 5-day regimen of postoperative, prophylactic, intravenous antibiotics compared with a 1-day regimen on the rate of surgical site infections within 1 year after surgery.DESIGN, SETTING, AND PARTICIPANTS This randomized clinical superiority trial was performed at 48 clinical sites in 12 countries from January 1, 2013, to October 29, 2019. The trial included patients with a primary bone tumor or a soft tissue sarcoma that had invaded the femur or tibia or oligometastatic bone disease of the femur or tibia with expected survival of at least 1 year who required surgical management by excision and endoprosthetic reconstruction. A total of 611 patients were enrolled, and 7 were excluded for ineligibility.INTERVENTIONS A 1-or 5-day regimen of postoperative prophylactic intravenous cephalosporin (cefazolin or cefuroxime) that began within 8 hours after skin closure and was administered every 8 hours thereafter. Those randomized to the 1-day regimen received identical saline doses every 8 hours for the remaining 4 days; patients, care providers, and outcomes assessors were blinded to treatment regimen. MAIN OUTCOMES AND MEASURESThe primary outcome in this superiority trial was a surgical site infection (superficial incisional, deep incisional, or organ space) classified according to the criteria established by the Centers for Disease Control and Prevention within 1 year after surgery. Secondary outcomes included antibiotic-related complications, unplanned additional operations, oncologic and functional outcomes, and mortality. RESULTSOf the 604 patients included in the final analysis (mean [SD] age, 41.2 [21.9] years; 361 [59.8%] male; 114 [18.9%] Asian, 43 [7.1%] Black, 34 [5.6%] Hispanic, 15 [2.5%] Indigenous, 384 [63.8%] White, and 12 [2.0%] other), 293 were randomized to a 5-day regimen and 311 to a 1-day regimen. A surgical site infection occurred in 44 patients (15.0%) allocated to the 5-day regimen and in 52 patients (16.7%) allocated to the 1-day regimen (hazard ratio, 0.93; 95% CI, 0.62-1.40; P = .73). Antibiotic-related complications occurred in 15 patients (5.1%) in the 5-day regimen and in 5 patients (1.6%) allocated to the 1-day regimen (hazard ratio, 3.24; 95% CI, 1.17-8.98; P = .02). Other secondary outcomes did not differ significantly between treatment groups.CONCLUSIONS AND RELEVANCE This randomized clinical trial did not confirm the superiority of a 5-day regimen of postoperative intravenous antibiotics over a 1-day regimen in preventing surgical site infections after surgery for lower extremity bone tumors that required an endoprosthesis. The 5-day regimen group had significantly more antibiotic-related complications.

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Postoperative deep infection in tumor endoprosthesis reconstruction around the knee

Cited by 39 publications

References 13 publications

Deep Infections after Endoprosthetic Replacement Operations in Orthopedic Oncology Patients

Deep Infections after Endoprosthetic Replacement Operations in Orthopedic Oncology Patients

High Infection Rate Outcomes in Long-bone Tumor Surgery with Endoprosthetic Reconstruction in Adults: A Systematic Review

Comparison of Prophylactic Intravenous Antibiotic Regimens After Endoprosthetic Reconstruction for Lower Extremity Bone Tumors

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