The effect of preoperative oral antibiotic use on the risk of periprosthetic joint infection after primary knee or hip replacement: a retrospective study with a 1-year follow-up

No Association Between Previous General Infection and Prosthetic Joint Infection After Total Hip Arthroplasty-A National Register-Based Cohort Study on 58,449 Patients Who Have Osteoarthritis

BACKGROUND

Prosthetic joint infection (PJI) following total hip arthroplasty (THA) is a complication associated with increased risk of death. There is limited knowledge about the association between infection before THA, and risk of revision due to PJI. We investigated the association between any previous hospital-diagnosed or community-treated infection 0 to 6 months before primary THA and the risk of revision.

METHODS

We obtained data on 58,449 patients who were operated with primary unilateral THA between 2010 and 2018 from the Danish Hip Arthroplasty Register. Information on previous infection diagnoses, redeemed antibiotic prescriptions up to 1 year before primary THA, intraoperative biopsies, and cohabitations was retrieved from Danish health registers. All patients had a 1-year follow-up. Primary outcome was revision due to PJI. Secondary outcome was any revision. We calculated the adjusted relative risk with 95% confidence intervals (CI), treating death as competing risk.

RESULTS

Among 1,507 revisions identified, 536 were due to PJI with a cumulative incidence of 1.0% ([CI] 0.9 to 1.2) and 0.9% ([CI] 0.8 to 1.0) for patients who did and did not have previous infection. For any revision, the cumulative incidence was 3.1% ([CI] 2.9 to 3.4) and 2.4% ([CI] 2.3 to 2.6) for patients who did and did not have previous infection. The adjusted relative risk for PJI revision was 1.1 ([CI] 0.9 to 1.4) and for any revision 1.3 ([CI] 1.1 to 1.4) for patients who did have previous infection compared to those who did not.

CONCLUSION

Previous hospital-diagnosed or community-treated infection 0 to 6 months before primary THA does not increase the risk of PJI revision. It may be associated with increased risk of any revision.

Pathogenic bacteria characteristics and drug resistance in acute, delayed, and chronic periprosthetic joint infection: A retrospective analysis of 202 patients

To assist orthopaedic surgeons in choosing appropriate antibiotics, this study attempted to identify the common microorganisms that cause periprosthetic joint infection (PJI) and their respective drug resistance spectrums. The clinical data of 202 patients with PJI after primary hip and knee arthroplasty between January 2017 and December 2021 were retrospectively analysed. There were 84 males and 118 females, aged (63.03 ± 13.10) years (range: 24-89 years). A total of 102 and 100 patients underwent total hip and total knee arthroplasty, respectively. Based on the time of postoperative infection, the patients were divided into acute (25 cases), delayed (91 cases), and chronic (86 cases) PJI groups. The results of pathogen species, composition ratio, and drug susceptibility tests were collected. Gram-positive bacteria were the primary causative pathogens of PJI (58.91%, 119/202), and their culture-positive rates in patients with acute, delayed, and chronic PJI were 32.00% (8/25), 62.64% (57/91), and 62.79% (54/86), respectively. Staphylococcus epidermidis and Staphylococcus aureus were the major gram-positive bacteria detected, followed by gram-negative bacteria (29/202, 14.36%), and fungi (4/202, 1.98%). Gram-positive bacteria showed higher resistance to penicillin (81.25%), oxacillin (63.33%), erythromycin (61.17%), and clindamycin (48.35%) and 100% sensitivity to linezolid, vancomycin, daptomycin, and tigecycline. In gram-negative bacteria, the drug resistance rates to cefazolin, gentamicin, furantoin, cefuroxime, ticacillin/clavulanic acid, ceftriaxone, ciprofloxacin, and tobramycin were >50%. However, no vancomycin-resistant bacteria were discovered in the current study. The drug resistance rate to carbapenems was low, ranging from 0% to 3.57%. Gram-positive bacteria are the main causative pathogens of PJI, and the resistance rate of pathogens of chronic PJI is higher than those of delayed and acute PJI. Use of cefuroxime and clindamycin in patients with PJIs should proceed with caution because of the high drug resistance rate. Vancomycin can be used as a first-line antibiotic against gram-positive bacteria. Carbapenems can be used as the first choice against gram-negative bacteria because of to their high sensitivity.

Layered Double Hydroxides: A Novel Promising 2D Nanomaterial for Bone Diseases Treatment

Bone diseases including bone defects, bone infections, osteoarthritis, and bone tumors seriously affect life quality of the patient and bring serious economic burdens to social health management, for which the current clinical treatments bear dissatisfactory therapeutic effects. Biomaterial-based strategies have been widely applied in the treatment of orthopedic diseases but are still plagued by deficient bioreactivity. With the development of nanotechnology, layered double hydroxides (LDHs) with adjustable metal ion composition and alterable interlayer structure possessing charming physicochemical characteristics, versatile bioactive properties, and excellent drug loading and delivery capabilities arise widespread attention and have achieved considerable achievements for bone disease treatment in the last decade. However, to the authors' best knowledge, no review has comprehensively summarized the advances of LDHs in treating bone disease so far. Herein, the advantages of LDHs for orthopedic disorders treatment are outlined and the corresponding state-of-the-art achievements are summarized for the first time. The potential of LDHs-based nanocomposites for extended therapeutics for bone diseases is highlighted and perspectives for LDHs-based scaffold design are proposed for facilitated clinical translation.

Pathogen distrbution and drug resistance in acute, delayed and chronic periprosthetic joint infection: a retrospective analysis of 202 patients.. [DOI: 10.21203/rs.3.rs-2111407/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Introduction To assist orthopedic surgeons to select appropriate antibiotics, this study identified the common microorganisms that caused PJI and their drug-resistant spectrum. Methods. The clinical data of 202 patients with PJI after primary knee and hip arthroplasty from January 2017 to December 2021 were retrospectively analyzed. According to the time of postoperative infection, the patients were divided into acute PJI group (25 cases), delayed PJI group (91 cases), and chronic PJI group (86 cases). The results of pathogen species, composition ratio, drug susceptibility tests were collected. Results.The main pathogens of PJI were Gram-positive bacteria (58.91%, 119/202), and the positive rates of culture in patients with acute PJI, delayed PJI and chronic PJI were 32.00% (8/25), 62.64% (57/91) and 62.79% (54/86), followed by gram-negative bacteria (29/202, 14.36%) and fungus (4/202, 1.98%). Staphylococcus epidermidis and Staphylococcus aureus played an important role as well, followed by gram-negative bacteria (29/202, 14.36%) and fungus (4/202, 1.98%). Penicillin (81.25%), oxacillin (63.33%), erythromycin (61.17%) and clindamycin (48.35%) showed high antibiotic resistance rate in gram-positive bacteria. The drug-sensitivity to linezolid, vancomycin, daptomycin and tigecycline was 100%. The drug resistance rate to carbapenems was low, ranging from 0 to 3.57%. Conclusions. The main pathogens of PJI are Gram-positive bacteria, and the drug resistance rate of chronic PJI is higher than that of delayed and acute PJI.

Patterns and Predictors of Outpatient Antibiotic Dispensation Following Total Hip and Knee Arthroplasty

BACKGROUND

This study aimed to evaluate the month-to-month prevalence of antibiotic dispensation in the 12 months before and after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and to identify factors associated with antibiotic dispensation in the month immediately following the surgical procedure.

METHODS

In total, 4,115 THAs and TKAs performed between April 2013 and June 2019 from a state-wide arthroplasty referral center were analyzed. A cross-sectional study used data from an institutional arthroplasty registry, which was linked probabilistically to administrative dispensing data from the Australian Pharmaceutical Benefits Scheme. Multivariable logistic regression was carried out to identify patient and surgical risk factors for oral antibiotic dispensation.

RESULTS

Oral antibiotics were dispensed in 18.3% of patients following primary TKA and 12.0% of patients following THA in the 30 days following discharge. During the year after discharge, 66.7% of TKA patients and 58.2% of THA patients were dispensed an antibiotic at some point. Patients with poor preoperative health status were more likely to have antibiotics dispensed in the month following THA or TKA. Older age, undergoing TKA rather than THA, obesity, inflammatory arthritis, and experiencing an in-hospital wound-related or other infectious complications were associated with increased antibiotic dispensation in the 30 days following discharge.

CONCLUSION

A high rate of antibiotic dispensation in the 30 days following THA and TKA has been observed. Although resource constraints may limit routine wound review for all patients by a surgeon, a select cohort may benefit from timely specialist review postoperatively. Several risk factors identified in this study may aid in identifying appropriate candidates for such changes to follow-up care.

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

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.