Preoperative and perioperative risk factors, and risk score development for prosthetic joint infection due to Staphylococcus aureus: A multinational matched case-control study
ARTHR-IS group
(2022) Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, volume 28, issue 10, pp. 1359 - 1366
(Article)
Abstract
Objectives: We aim to identify the preoperative and perioperative risk factors associated with post-surgical Staphylococcus aureus prosthetic joint infections (PJI) and to develop and validate risk-scoring systems, to allow a better identification of high-risk patients for more efficient targeted interventions. Methods: We performed a multicenter matched case-control study of patients
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who underwent a primary hip and knee arthroplasty from 2014 to 2016. Two multivariable models by logistic regression were performed, one for the preoperative and one for perioperative variables; predictive scores also were developed and validated in an external cohort. Results: In total, 130 cases and 386 controls were included. The variables independently associated with S. aureus-PJI in the preoperative period were (adjusted OR; 95% CI): body mass index >30 kg/m 2 (3.0; 1.9 to 4.8), resident in a long-term care facility (2.8; 1.05 to 7.5), fracture as reason for arthroplasty (2.7; 1.4 to 5.03), skin disorders (2.5; 0.9 to 7.04), previous surgery in the index joint (2.4; 1.3 to 4.4), male sex (1.9; 1.2 to 2.9) and American Society of Anesthesiologists index score 3 to 4 (1.8; 1.2 to 2.9). The area under the receiver operating characteristic curve was 0.73 (95% CI 0.68 to 0.78). In perioperative model, the risk factors were the previous ones plus surgical antibiotic prophylaxis administered out of the first 60 minutes before incision (5.9; 2.1 to 16.2), wound drainage for >72 hours after arthroplasty (4.5; 1.9 to 19.4) and use of metal bearing material versus ceramic (1.9; 1.1 to 3.3). The area under the receiver operating characteristic curve was 0.78 (95% CI 0.72 to 0.83). The predictive scores developed were validated in the external cohort. Discussion: Predictive scores for S. aureus-PJI were developed and validated; this information would be useful for implementation of specific preventive measures.
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Keywords: Arthroplasty, Case-control study, Multinational study, Prosthetic joint infection, Risk factors, Staphylococcus aureus, Microbiology (medical), Infectious Diseases, Journal Article
ISSN: 1198-743X
Publisher: Elsevier Limited
Note: Funding Information: The research leading to these results has received support from the Innovative Medicines Initiative Joint Undertaking under grant agreement No. 115523, COMBACTE-NET consortium (European Union FP7/2007–2013 and GlaxoSmithKline Biologicals SA, as EFPIA partner). Funding Information: Many researchers at each institution have helped to make this study possible. We are deeply indebted to the following collaborators and members of the ARTHR-IS group: Nienke Cuperus and Giuseppe Manfré (Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands) collaborated in the selection process of the participating centers. Eleonora Zamparini (Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy), Stéphanie Verhagen (Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, the Netherlands), Juan P. Horcajada, Joan Gómez Junyent, and Albert Alier (Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Pompeu Fabra, Barcelona, Spain), Laura Soldevila (Servicio Enfermedades Infecciosas Hospital Universitari Bellvitge. IDIBELL, Barcelona, Spain), Miranda van Rijen and Jannie Romme (Amphia Hospital, Breda, Netherlands), Juliane Ankert (Jena University Hospital, Jena, Germany), Celia Whitehouse and Adrian Jones (Norfolk and Norwich University Hospital, Norwich, UK), Javier Cobo and Javier Moreno (Hospital Universitario Ramón y Cajal, Madrid, Spain), Anne Meheut (Centre Hospitalier Universitaire de Rennes, Rennes, France), Claire Gledel (Orthopedic surgery department, Croix Rousse Hospital, Lyon, France), Pauline Perreau (Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France), Remco J.A. van Wensen (Department of Orthopaedic Surgery & Trauma, Catharina Hospital, Eindhoven, the Netherland), and Gabriella Lindergard (North Manchester General Hospital, Manchester, UK) collaborated in the data collection. We also appreciate the collaboration of the authors of the publication of the cohort of patients with prosthetic joint infection where it has been possible to validate the results of this work: Cecilia Peñas (at the time of publication, Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain); Ana Conde Albarracín (Orthopedic and Traumatology Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain); Julián Palomino (Infectious Diseases Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain); Francisco Brun (at the time of publication, Internal Medicine Unit, Hospital Universitario Puerta del Mar, Cádiz, Spain); Santiago Sánchez (at the time of publication, Orthopedic and Traumatology Unit, Hospital Universitario Puerta del Mar, Cádiz, Spain). Funding Information: RE, NB, IM, ST, NR, JH, LS, OM, MS, CS, JK, MCF, MP, IM, RE-S, CA, CB, F-AD, W-YL, JL-T, JP, JU, JR-B, and MDDT declare not to have no conflicts of interest. VV, EC, MP, and FB are employees of the GSK group of companies and have nonfinancial interest to declare. VV, MP, and FB hold shares in the GSK group of companies. FB holds pending and issued patents on Staphylococcus aureus vaccine formulations. RE, LS, OM, EE-S, JL-T, JP, JR-B, and MDDT are members of the Spanish Network for Research in Infectious Diseases (REIPI), supported by Plan Nacional de I + D + i 2013-2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001; 0002; 0005; 0009; 0011; 0015), co-financed by European Development Regional Fund “A way to achieve Europe,” Operative Program Intelligence Growth 2014-2020. GlaxoSmithKline Biologicals SA was provided the opportunity to review a version of this manuscript for factual accuracy; authors are solely responsible for final content and interpretation. Publisher Copyright: © 2022
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