Reporting Surgical Site Infections Following Total Hip and Knee Arthroplasty: Impact of Limiting Surveillance to the Operative Hospital

Yokoe, Deborah S.; Avery, Taliser R.; Platt, Richard; Huang, Susan S.

doi:10.1093/cid/cit516

Cited by 79 publications

(80 citation statements)

References 4 publications

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“…This information would have been interesting, since the MIC 90 of teicoplanin for CoNS is 8 mg/liter (www.eucast.org/mic_distributions/) and could explain the lower efficacy of teicoplanin in preventing CoNS infection. Finally, the follow-up period of the study was 100 days, whereas the majority of authors recommend 365 days; however, recent studies (28) confirm that the majority of infections after arthroplasty occur within the first 3 months and only a minor number are detected afterwards, supporting the change made by the National Healthcare Safety Network (NHSN) in January 2013 to use a 90-day surveillance period for these procedures.…”

Section: Discussionmentioning

confidence: 95%

Prophylaxis with Teicoplanin and Cefuroxime Reduces the Rate of Prosthetic Joint Infection after Primary Arthroplasty

Tornero

García-Ramiro

Martínez-Pastor

et al. 2015

Antimicrob Agents Chemother

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The aim of this study was to compare the prosthetic joint infection (PJI) rate after total joint arthroplasty in two consecutive periods of treatment with different antibiotic prophylaxes: cefuroxime versus cefuroxime plus teicoplanin. We retrospectively reviewed 1,896 patients who underwent total hip arthroplasty or total knee arthroplasty between March 2010 and February 2013. From March 2010 to August 2011, patients received 1.5 g of cefuroxime during induction of anesthesia and another 1.5 g 2 h later (the C group). From September 2011, 800 mg of teicoplanin was added to cefuroxime (the CT group). Throughout the period studied, there were no variations in pre-or postoperative protocols. Univariate and multivariate analyses were performed to evaluate independent predictors of PJI. There were 995 (55.7%) patients in the C group and 791 (44.3%) in the CT group. Patients in the CT group had a significantly lower PJI rate than patients in the C group (1.26% versus 3.51%, P ‫؍‬ 0.002). There were no infections due to Staphylococcus aureus in the CT group (0% versus 1.6% in the C group, P < 0.001). A stepwise forward Cox regression model identified male sex (hazard ratio [HR], 3.85; 95% confidence interval [CI], 2.09 to 7.18), a body mass index of >35 kg/m 2 (HR, 2.93; 95% CI, 1.37 to 6.27), the presence of lung disease (HR, 2.46; 95% CI, 1.17 to 5.15), and red blood cell transfusion (HR, 3.70; 95% CI, 1.89 to 7.23) to be independent variables associated with a higher risk of PJI. The addition of teicoplanin was associated with a lower risk of infection (HR, 0.35; 95% CI, 0.17 to 0.74). In conclusion, the addition of teicoplanin to cefuroxime during primary arthroplasty was associated with a significant reduction in the global PJI rate due to a reduction of infections caused by Gram-positive bacteria.

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Section: Discussionmentioning

confidence: 95%

Prophylaxis with Teicoplanin and Cefuroxime Reduces the Rate of Prosthetic Joint Infection after Primary Arthroplasty

Tornero

García-Ramiro

Martínez-Pastor

et al. 2015

Antimicrob Agents Chemother

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“…To the best of our knowledge, no European studies and only a few American and Canadian studies have analysed timing of SSIs to quantify the impact of a shorter PDS duration [10,[15][16][17][18]. None of these studies used survival techniques to visually demonstrate the accumulation of SSIs over time.…”

Section: Comparison With Literaturementioning

confidence: 99%

Post-discharge surveillance (PDS) for surgical site infections: a good method is more important than a long duration

et al. 2015

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Post-discharge surveillance (PDS) for surgical site infections (SSIs) normally lasts 30 days, or one year after implant surgery, causing delayed feedback to healthcare professionals. We investigated the effect of shortened PDS durations on SSI incidence to determine whether shorter PDS durations are justified. We also studied the impact of two national PDS methods (those mandatory since 2009 ('mandatory') and other methods acceptable before 2009 ('other')) on SSI incidence. From Dutch surveillance (PREZIES) data (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008), four implant-free surgeries (breast amputation, Caesarean section, laparoscopic cholecystectomy and colectomy) and two implant surgeries (knee replacement and total hip replacement) were selected . We studied the impact of PDS duration and method on SSI incidences by survival and Cox regression analyses. We included 105,607 operations. Shortened PDS duration for implant surgery from one year to 90 days resulted in 6-14% of all SSIs being missed. For implant-free procedures, PDS reduction from 30 to 21 days caused similar levels of missed SSIs. In contrast, up to 62% of SSIs (for cholecystectomy) were missed if other instead of mandatory PDS methods were used. Inferior methods of PDS, rather than shortened PDS durations, may lead to greater underestimation of SSI incidence. Our data validate international recommendations to limit the maximum PDS duration (for implant surgeries) to 90 days for surveillance purposes, as this provides robust insight into trends.

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“…203 Advances in data mining, data linkage and electronic surveillance systems make post-discharge patient information more easily obtainable than previously. [204][205][206] This means that the distinction between active and passive PDS will be blurred, and that passive PDS may become more sensitive in the future.…”

Section: Challenges In Automated Case-findingmentioning

confidence: 99%

“…[204][205][206] This means that the distinction between active and passive PDS will be blurred, and that passive PDS may become more sensitive in the future. 88,89,141,191,203,207,208 Regardless of degree of automation and data sources, passive PDS requires high quality systems for data harvesting and good and uniform coding practices by health care personnel. 155 Additionally, using data for a purpose for which they were not intended can mean that they are not appropriate for the task.…”

Section: Challenges In Automated Case-findingmentioning

confidence: 99%

Methodology of the Norwegian Surveillance System for Healthcare-Associated Infections: The value of a mandatory system, automated data collection, and active postdischarge surveillance

Løwer

Eriksen

Aavitsland

et al. 2013

American Journal of Infection Control

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Reporting Surgical Site Infections Following Total Hip and Knee Arthroplasty: Impact of Limiting Surveillance to the Operative Hospital

Abstract: Limiting SSI surveillance to the operative hospital caused varying degrees of SSI underestimation and substantially impacted hospitals' relative rankings, suggesting that alternative methods for comprehensive postdischarge surveillance are needed for accurate benchmarking.

Cited by 79 publications

References 4 publications

Prophylaxis with Teicoplanin and Cefuroxime Reduces the Rate of Prosthetic Joint Infection after Primary Arthroplasty

Prophylaxis with Teicoplanin and Cefuroxime Reduces the Rate of Prosthetic Joint Infection after Primary Arthroplasty

Post-discharge surveillance (PDS) for surgical site infections: a good method is more important than a long duration

Methodology of the Norwegian Surveillance System for Healthcare-Associated Infections: The value of a mandatory system, automated data collection, and active postdischarge surveillance

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