Prevention of periprosthetic joint infection

Parvızı, Javad; Shohat, Noam; Gehrke, Thorsten

doi:10.1302/0301-620x.99b4.bjj-2016-1212.r1

Cited by 138 publications

(95 citation statements)

References 82 publications

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“…Antibiotics like rifampin has been commonly used in combination with other antibiotics to treat S. aureus infections, and has seemed to be promising in treating orthopedic implant-associated infections; however, data supporting this practice are limited and more definitive data are lacking. 51 Guidelines for prophylaxis and treatment of orthopedic infections have been established, [52][53][54] and if implemented worldwide, they could have immense impact on healthcare policy and practices. These principles and guidelines will enable orthopedic surgeons to be more effective in preventing infections and reducing the use of antibiotics.…”

Section: Challenges Opportunities and Obligations Related To Bactermentioning

confidence: 99%

Bacteria antibiotic resistance: New challenges and opportunities for implant‐associated orthopedic infections

Webster

2017

Journal Orthopaedic Research

667

427

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There has been a dramatic increase in the emergence of antibiotic resistant bacterial strains, which has made antibiotic choices for infection control increasingly limited and more expensive. In the U.S. alone, antibiotic resistant bacteria cause at least 2 million infections and 23,000 deaths a year resulting in a $55-70 billion per year economic impact. Antibiotics are critical to the success of surgical procedures including orthopaedic prosthetic surgeries, and antibiotic resistance is occurring in nearly all bacteria that infect people, including the most common bacteria that cause orthopaedic infections, such as Staphylococcus aureus (S. aureus). Most clinical cases of orthopaedic surgeries have shown that patients infected with antibiotic resistant bacteria, such as methicillin resistant S. aureus (MRSA), are associated with increased morbidity and mortality. This paper reviews the severity of antibiotic resistance at the global scale, the consequences of antibiotic resistance, and the pathways bacteria used to develop antibiotic resistance. It highlights the opportunities and challenges in limiting antibiotic resistance through approaches like the development of novel, non-drug approaches to reduce bacteria functions related to orthopaedic implant-associated infections.

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Section: Challenges Opportunities and Obligations Related To Bactermentioning

confidence: 99%

Bacteria antibiotic resistance: New challenges and opportunities for implant‐associated orthopedic infections

Webster

2017

Journal Orthopaedic Research

667

427

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“…Although previous efforts to improve guideline adherence among orthopedic surgeons have not always been successful, 41,42 the rising incidence and dramatic care costs associated with PJI mandate an earnest effort at both the institutional and national levels. It is hoped that these efforts as well as published attempts for consensus among experts 43,44 will help clarify what features of PJI diagnosis and management are the most effective.…”

Section: Resultsmentioning

confidence: 99%

Tertiary care centre adherence to unified guidelines for management of periprosthetic joint infections: a gap analysis

Armstrong

Carli

Abdelbary

et al. 2018

cjs

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Background:The success rate of surgical treatment for periprosthetic joint infection (PJI) remains inconsistent in the literature. Variability in PJI clinical guidelines and surgeon adherence to guidelines could affect treatment success. The objectives of this study were to appraise current recommendations for PJI management and develop a unified clinical standard of care, to perform a gap analysis of PJI cases in a tertiary institution to determine the rate of guideline adherence, and to determine if adherence to unified PJI guidelines affected 2-year treatment outcomes. Methods: We appraised the PJI guidelines from 3 academic medical societies, and consistent statements were aggregated. We retrospectively reviewed all PJI cases in a tertiary care institution. We defined PJI based on Musculoskeletal Infection Society PJI criteria. Surgeon adherence to preoperative, intraoperative, surgical and medical management guidelines was calculated, and we evaluated the association between guideline adherence and 2-year treatment outcomes. Results: The institutional rate of PJI was 1.13% (38 of 3368). Treatment success was 57.8% at 2 years. Unified guideline adherence percentages varied substantially: 92% of patients had preoperative erythrocyte sedimentation rate and C-reactive protein, 97% had intraoperative tissue cultures, 42% had appropriate preoperative arthrocentesis, and 74% underwent guideline-appropriate surgery. Performing appropriate preoperative arthrocentesis significantly correlated with positive treatment outcomes at 2 years (p = 0.028). Conclusion: Adherence to PJI guidelines varies considerably, indicating that clinicians are either unaware of them or do not recognize their value for PJI treatment. This study shows the need for institution-based PJI treatment pathways that are consistent with published guidelines and the need to monitor adherence. Contexte :Les études ne concordent pas quant au taux de réussite du traitement chirurgical des infections de prothèses articulaires (IPA). Une certaine variabilité dans les lignes directrices sur ces infections et dans l'adhésion des chirurgiens à celles-ci pourrait nuire à la réussite du traitement. La présente étude visait à évaluer les recommandations actuelles sur la prise en charge des IPA afin d'élaborer une norme de soins uniforme, à effectuer une analyse des lacunes entourant les cas d'IPA dans un établissement de soins tertiaires pour déterminer le taux d'adhésion aux lignes directrices, et à déterminer si l'adhésion à des lignes directrices uniformes influençait les issues de traitement après 2 ans. Méthodes : Nous avons évalué les lignes directrices sur les IPA de 3 sociétés médi-cales universitaires, et agrégé des énoncés cohérents. Nous avons également examiné de façon rétrospective tous les cas d'IPA dans un établissement de soins tertiaires. Aux fins de notre étude, l'IPA était définie selon les critères de la Musculoskeletal Infection Society. Nous avons calculé l'adhésion des chirurgiens aux lignes directrices de prise en charge préopératoire, ...

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“…Понятно лишь, что указания на незначительное число инфекционных осложнений (менее 1%) [36] и высокую эффективность ее лечения (более 95% эрадикации) [37] не совсем соответствуют действительности. Иначе сложно объяснить, почему в СШа при выполнении полутора миллио-нов операций эндопротезирования крупных суставов выполняется ежегодно более 38 тысяч вмешательств по поводу перипротезной инфекции [38]. Основным фактором успеха в лечении перипротезной инфекции является своевременное признание проблемы и соответствующие тяжести процесса лечебные мероприятия [39].…”

Section: факторы риска ревизий при первичном эндопротезировании тбсunclassified

What Has Changed in the Structure of Revision Hip Arthroplasty?

Shubnyakov

Шубняков²,

Тихилов³

et al. 2019

Traumatology and Orthopedics of Russia

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The key aspects of the study: 1) what has changed in the structure of revisions in recent years? 2) what is the spectrum of reasons for revision after primary hip arthroplasty and re-revision? 3) what are the demographic features of patients’ population undergoing the revision? Materials and methods. The authors conducted a retrospective evaluation of 2415 hip revision cases during the period of time from 2014 until 2018. Separately the authors assessed revisions after primary surgeries and re-revisions as well as the group of early revisions. Results. In the period from 2014 until 2018 the overall share of revisions was 16,6% from all total hip arthroplasties, at the same time the authors reported the absolute 1.7 times increase in number of revisions as well as increased share of revisions in the total structure of hip arthroplasty from 12,5% to 18,9% without significant variances in the number of primary procedures. The share of early revisions increased from 32.9% in 2013 to 56.7% while the number of early revisions amounted to 37.4% of all primary revisions. Gender composition in primary and revision hip arthroplasty varied insignificantly. Mean age at the moment of hip revision was 59.2% (95% CI from 58.7 to 59.7; Me 60 years) which is slightly less than in primary replacement — 60.2 years (95% CI from 58.9 to 61.1; Me 62 years), but such variances had a high statistical significance, р0.001. The main reasons for primary revisions were aseptic loosening of prosthesis components (50.3%), infection (27.6%), polyethylene wear and osteolysis (9.0%) as well as dislocations (6,2%). Re-revisions structure featured prevalence of infection (69.0%), aseptic loosening (20.8%) and dislocations (7,8%). Mean period of time after primary hip arthroplasty to revision was 7.9 years (95% CI from 7.7 to 8.2; Me 7.3), to first re-revision — 2.9 (95% CI from 2.6 to 3.2; Me 1.2), to second re-revision — 2.2 (95% CI from 1.8 to 2.7; Me 1.1), to third — 2,2 (95% CI from 1.7 to 2.8; Me 1.1), to fourth — 1.0 (95% CI from 0.6 to 1.3; Me 0.6), remaining cases demonstrated rather high heterogeneity. Conclusion. In the result of the present study the authors observed increased number of all revision hip arthroplasties, especially the share of early revisions within first five years from the moment of previous surgery. The most often reason for revision after primary hip arthroplasty was aseptic loosening of one or both components of prosthesis. Infection was the absolute leader in the group of re-revisions constituting over half of all reasons for secondary intervention.

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Prevention of periprosthetic joint infection

Cited by 138 publications

References 82 publications

Bacteria antibiotic resistance: New challenges and opportunities for implant‐associated orthopedic infections

Bacteria antibiotic resistance: New challenges and opportunities for implant‐associated orthopedic infections

Tertiary care centre adherence to unified guidelines for management of periprosthetic joint infections: a gap analysis

What Has Changed in the Structure of Revision Hip Arthroplasty?

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