The incidence rate, trend and microbiological aetiology of prosthetic joint infection after total knee arthroplasty: A 13 years’ experience from a tertiary medical center in Taiwan

Wang, Fu‐Der; Wang, Yuping; Chen, Cheng Fong; Chen, Hsin-Pai

doi:10.1016/j.jmii.2018.08.011

Cited by 33 publications

(24 citation statements)

References 23 publications

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“…We also found that MDR nonfermenters and MDR S. aureus rates were higher at tropical sites vs. subtropical. Reported cases of MDR nonfermenters in the orthopaedic literature are too low to be comparable; however, we note that our rates of MDR S. aureus are consistent with other studies [20,21,[23][24][25][26]. In their assessment of pathogens cultured from surgical site infections following joint arthroplasty and spinal fusions, Norton et al found that 33% of S. aureus was methicillin-resistant and similarly, Dudareva et al identified that 22.5% of S. aureus species cultured from chronic osteomyelitis patients in the United Kingdom were MDR [20,24].…”

Section: Discussionsupporting

confidence: 91%

“…In their cohort of orthopaedic trauma patients in Brazil, Tuon [20][21][22]. In Taiwan, Wang et al also identified lower rates of P. aeruginosa, which made up just 2.8% of pathogens causing prosthetic joint infection [23]. Though the mechanisms are unclear, in our study, the higher frequency of nonfermenters identified at tropical vs. sub-tropical sites likely reflects a predilection of these pathogens for included regions, and the complexity of niches may mean that, even within tropical environments, there are regions of varying suitability for these organisms.…”

Section: Discussionmentioning

confidence: 99%

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Bacterial Profile, Multi-Drug Resistance and Seasonality Following Lower Limb Orthopaedic Surgery in Tropical and Subtropical Australian Hospitals: An Epidemiological Cohort Study

Vickers

Ballard

Harris

et al. 2020

IJERPH

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We aimed to describe the epidemiology, multi-drug resistance and seasonal distribution of bacteria cultured within 12 months following lower limb orthopaedic surgery in tropical and subtropical Australian hospitals between 2010 and 2017. We collected data from four tropical and two subtropical hospitals. Categorical variables were examined using the Pearson Chi-squared test or Fisher’s Exact test, and continuous variables with the Student t-test or Mann–Whitney U test. A Poisson regression model was used to examine the relationship between season, weather and the incidence of Staphylococcus and nonfermentative species. We found that at tropical sites, nonfermenters (Pseudomonas aeruginosa and Acinetobacter baumannii) were more common (28.7% vs. 21.6%, p = 0.018), and patients were more likely to culture multi-drug-resistant (MDR) nonfermenters (11.4% vs. 1.3%, p = 0.009) and MDR Staphylococcus aureus (35.9% vs. 24.6%, p = 0.006). At tropical sites, patients were more likely to be younger (65.9 years vs. 72.0, p = < 0.001), male (57.7% vs. 47.8%, p = 0.005), having knee surgery (45.3% vs. 34.5%, p = 0.002) and undergoing primary procedures (85.0% vs. 73.0%, p = < 0.001). Species were similar between seasons in both tropical and subtropical hospitals. Overall, we found that following lower limb orthopaedic surgery in tropical compared with subtropical Australia, patients were more likely to culture nonfermenters and some MDR species.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Bacterial Profile, Multi-Drug Resistance and Seasonality Following Lower Limb Orthopaedic Surgery in Tropical and Subtropical Australian Hospitals: An Epidemiological Cohort Study

Vickers

Ballard

Harris

et al. 2020

IJERPH

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“…There are several useful classifications of PJI in different categories, namely based on the mode of acquisition and/or time from prosthesis implantation, but none of them are universally accepted [8,16]. A good deal of what is currently known about the microbial etiology of different categories of PJI is based on studies that are limited by small sample sizes [11,15,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31] and describe single-center experiences [12,15,17,18,19,20,21,22,23,24,26,27,28,30,31,32]. Most focus on specific types of infection, [11,21,23,25,29] surgical strategies used during treatment [22,31], or include only infections occurring within a limited period of time after prosthesis implantation [30,33].…”

Section: Introductionmentioning

confidence: 99%

The Different Microbial Etiology of Prosthetic Joint Infections according to Route of Acquisition and Time after Prosthesis Implantation, Including the Role of Multidrug-Resistant Organisms

Benito

Mur

Ribera

et al. 2019

JCM

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The aim of our study was to characterize the etiology of prosthetic joint infections (PJIs)—including multidrug-resistant organisms (MDRO)—by category of infection. A multicenter study of 2544 patients with PJIs was performed. We analyzed the causative microorganisms according to the Tsukayama’s scheme (early postoperative, late chronic, and acute hematogenous infections (EPI, LCI, AHI) and “positive intraoperative cultures” (PIC)). Non-hematogenous PJIs were also evaluated according to time since surgery: <1 month, 2–3 months, 4–12 months, >12 months. AHIs were mostly caused by Staphylococcus aureus (39.2%) and streptococci (30.2%). EPIs were characterized by a preponderance of virulent microorganisms (S. aureus, Gram-negative bacilli (GNB), enterococci), MDROs (24%) and polymicrobial infections (27.4%). Conversely, coagulase-negative staphylococci (CoNS) and Cutibacterium species were predominant in LCIs (54.5% and 6.1%, respectively) and PICs (57.1% and 15.1%). The percentage of MDROs isolated in EPIs was more than three times the percentage isolated in LCIs (7.8%) and more than twice the proportion found in AHI (10.9%). There was a significant decreasing linear trend over the four time intervals post-surgery for virulent microorganisms, MDROs, and polymicrobial infections, and a rising trend for CoNS, streptococci and Cutibacterium spp. The observed differences have important implications for the empirical antimicrobial treatment of PJIs.

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“…Although international efforts to minimize the risk of these infections are ongoing, PJIs continue to develop in alarming numbers. Current estimates of the rate of PJI range between 0.5% and 2.4% of primary hip and knee arthroplasties [7], and PJI can complicate up to 20% of revision arthroplasties [8,9]. Some authors have suggested that these numbers for primary total joint arthroplasty are both underestimated and increasing [10].…”

Section: Introductionmentioning

confidence: 99%

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

Gallo

Nieslanikova

2020

JCM

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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.

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The incidence rate, trend and microbiological aetiology of prosthetic joint infection after total knee arthroplasty: A 13 years’ experience from a tertiary medical center in Taiwan

Cited by 33 publications

References 23 publications

Bacterial Profile, Multi-Drug Resistance and Seasonality Following Lower Limb Orthopaedic Surgery in Tropical and Subtropical Australian Hospitals: An Epidemiological Cohort Study

Bacterial Profile, Multi-Drug Resistance and Seasonality Following Lower Limb Orthopaedic Surgery in Tropical and Subtropical Australian Hospitals: An Epidemiological Cohort Study

The Different Microbial Etiology of Prosthetic Joint Infections according to Route of Acquisition and Time after Prosthesis Implantation, Including the Role of Multidrug-Resistant Organisms

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

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