Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Abstract

A projected increased use of total joint arthroplasties will naturally result in a related increase in the number of prosthetic joint infections (PJIs). Suppression of the local peri-implant immune response counters efforts to eradicate bacteria, allowing the formation of biofilms and compromising preventive measures taken in the operating room. For these reasons, the prevention of PJI should focus concurrently on the following targets: (i) identifying at-risk patients; (ii) reducing “bacterial load” perioperatively; (iii) creating an antibacterial/antibiofilm environment at the site of surgery; and (iv) stimulating the local immune response. Despite considerable recent progress made in experimental and clinical research, a large discrepancy persists between proposed and clinically implemented preventative strategies. The ultimate anti-infective strategy lies in an optimal combination of all preventative approaches into a single “clinical pack”, applied rigorously in all settings involving prosthetic joint implantation. In addition, “anti-infective” implants might be a choice in patients who have an increased risk for PJI. However, further progress in the prevention of PJI is not imaginable without a close commitment to using quality improvement tools in combination with continual data mining, reflecting the efficacy of the preventative strategy in a particular clinical setting.

Bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at a tertiary teaching hospital in Ethiopia: a prospective cohort study

“…Hematogenous spread of organisms from distant sources of infection can rarely cause SSI by attachment to the prosthesis or other implant left in the operative site. The infection prevention and control practices of SSI are therefore aimed at minimizing the number of pathogens at surgical site [ 12 , 13 ].…”

Periprosthetic joint infection after total knee arthroplasty: a bibliometrics analysis

“…al recommended the nutritional status of patients be evaluated before joint replacement surgery, including indicators such as serum albumin level, lymphocyte count, and transferrin level (17). During the operation, strict disinfection should be performed on the skin of the surgical area (18,19), and the addition of disinfection records can also reduce the risk of infection (20,21). There are many studies on the use of antibiotics for preventive treatment during the perioperative period, but the optimal plan requires further study.…”

Antimicrobial Peptides in the Battle against Orthopedic Implant-Related Infections: A Review

“…More complex PJIs preventative measures have been progressively applied in clinical practice, including perioperative and postoperative strategies [18]. However, in some cases, infection develops and current treatment includes antibiotherapy, which relies on systemic administration of a combination of antibiotics, such as rifampicin, daptomycin, fluoroquinolones, vancomycin, or amikacin [19].…”