Hostname: page-component-848d4c4894-hfldf Total loading time: 0 Render date: 2024-05-18T23:18:15.663Z Has data issue: false hasContentIssue false
  • English
  • Français

Periprosthetic Infection following Primary Hip and Knee Arthroplasty: The Impact of Limiting the Postoperative Surveillance Period

Published online by Cambridge University Press:  11 November 2016

Virginia R. Roth ,
Robyn Mitchell ,
Julie Vachon ,
Stéphanie Alexandre ,
Kanchana Amaratunga ,
Stephanie Smith ,
Mary Vearncombe ,
Ian Davis ,
Dominik Mertz  and
Elizabeth Henderson
...Show all authors
Virginia R. Roth
Affiliation:
Department of Medicine and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawaand Ottawa Hospital Research Institute. Ottawa, Ontario, Canada
Robyn Mitchell
Affiliation:
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
Julie Vachon
Affiliation:
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
Stéphanie Alexandre
Affiliation:
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
Kanchana Amaratunga
Affiliation:
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
Stephanie Smith
Affiliation:
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Mary Vearncombe
Affiliation:
Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario, Canada
Ian Davis
Affiliation:
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
Dominik Mertz
Affiliation:
Departments of Medicine, Clinical Epidemiology and Biostatistics, Pathology and Molecular Medicine, and Michael G. DeGroote Institute for Infectious Diseases Research, McMaster University, Hamilton, Ontario, Canada
Elizabeth Henderson
Affiliation:
Alberta Health Services and Department of Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
Michael John
Affiliation:
Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
Lynn Johnston
Affiliation:
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
Camille Lemieux
Affiliation:
University Health Network, Toronto, Ontario, Canada
Linda Pelude
Affiliation:
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
Denise Gravel
Affiliation:
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
Get access Rights & Permissions [Opens in a new window]

Abstract

BACKGROUND

Hip and knee arthroplasty infections are associated with considerable healthcare costs. The merits of reducing the postoperative surveillance period from 1 year to 90 days have been debated.

OBJECTIVES

To report the first pan-Canadian hip and knee periprosthetic joint infection (PJI) rates and to describe the implications of a shorter (90-day) postoperative surveillance period.

METHODS

Prospective surveillance for infection following hip and knee arthroplasty was conducted by hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) using standard surveillance definitions.

RESULTS

Overall hip and knee PJI rates were 1.64 and 1.52 per 100 procedures, respectively. Deep incisional and organ-space hip and knee PJI rates were 0.96 and 0.71, respectively. In total, 93% of hip PJIs and 92% of knee PJIs were identified within 90 days, with a median time to detection of 21 days. However, 11%–16% of deep incisional and organ-space infections were not detected within 90 days. This rate was reduced to 3%–4% at 180 days post procedure. Anaerobic and polymicrobial infections had the shortest median time from procedure to detection (17 and 18 days, respectively) compared with infections due to other microorganisms, including Staphylococcus aureus.

CONCLUSIONS

PJI rates were similar to those reported elsewhere, although differences in national surveillance systems limit direct comparisons. Our results suggest that a postoperative surveillance period of 90 days will detect the majority of PJIs; however, up to 16% of deep incisional and organ-space infections may be missed. Extending the surveillance period to 180 days could allow for a better estimate of disease burden.

Infect Control Hosp Epidemiol 2017;38:147–153

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 2 , February 2017 , pp. 147 - 153
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

Members of the Canadian Nosocomial Infection Surveillance Program: Alice Wong, Royal University Hospital, Saskatoon, SK; Allison McGeer, Mount Sinai Hospital, Toronto, ON; Andrew Simor, Sunnybrook Health Sciences Centre, Toronto, ON; Bonita Lee, Stollery Children’s Hospital, Edmonton, AB; Camille Lemieux, University Health Network, Toronto, ON; Caroline Quach, Montreal Children’s Hospital, Montreal, QC; Charles Frenette, McGill University Health Centre, Montreal, QC; Chelsey Ellis,The Moncton Hospital, Moncton, NB; Deanna Hembroff, University Hospital of Northern BC, Prince George, BC; Dominik Mertz, Hamilton Health Sciences Corporation, Hamilton, ON; Dorothy Moore, Montreal Children’s Hospital, Montreal, QC; Elizabeth Bryce, Vancouver Coastal Health Authority, Vancouver, BC; Elizabeth Henderson, Alberta Health Services, Calgary, AB; Geoffrey Taylor, University of Alberta Hospital, Edmonton, AB; Gerald Evans, Kingston General Hospital, Kingston, ON; Gregory German, Queen Elizabeth Hospital, Charlottetown, PEI; Ian Davis, QEII Health Sciences Centre, Halifax, NS; Janice de Heer, Interior Health Authority, Kelowna, BC; Jessica Minion, Regina Qu’Appelle Health Region, Regina, SK; Joanne Embree, Health Sciences Centre, Winnipeg, MB; Joanne Langley, IWK.Health Centre, Halifax, NS; Jocelyn Srigley, Children and Women’s Hospital of British Columbia, Vancouver, BC; John Conly, Foothills Medical Centre, Calgary, AB; John Embil, Health Sciences Centre, Winnipeg, MB; Joseph Vayalumkal, Alberta Children’s Hospital, Calgary, AB; Karl Weiss, Maisonneuve-Rosemont Hospital, Montreal, QC; Kathryn Suh, The Ottawa Hospital, Ottawa, ON; Kevin Katz, North York General Hospital, Toronto, ON; Lynn Johnston, Queen Elizabeth II Health Sciences Centre, Halifax, NS; Marie-Astrid Lefebvre, Montreal Children’s Hospital, Montreal, QC; Mark Loeb, Hamilton Health Sciences Corporation, Hamilton, ON; Mary Vearncombe, Sunnybrook Health Sciences Centre, Toronto, ON; Michael John, London Health Sciences Centre, London, ON; Natalie Bridger, Eastern Health-HSC, St. John’s, NL; Nathalie Turgeon, CHUQ-Hôtel-Dieu, Québec, QC; Nisha Thampi, Children’s Hospital of Eastern Ontario, Ottawa, ON; Pamela Kibsey, Royal Jubilee Hospital, Victoria, BC; Paula Stagg, Western Memorial Hospital, Corner Brook, NL; Stephanie Smith, University of Alberta Hospital, Edmonton, AB; Susan Richardson, Hospital for Sick Children, Toronto, ON; Suzanne Pelletier, Health Sciences North, Sudbury, ON; Virginia Roth, The Ottawa Hospital, Ottawa, ON; Yves Longtin, SMBD-Jewish General Hospital, Montreal, QC.

References

REFERENCES

1. Gravel, D, Taylor, G, Ofner, M, et al. Point prevalence survey for healthcare-associated infections within Canadian adult acute-care hospitals. J Hosp Infect 2007;66:243–248.CrossRefGoogle ScholarPubMed
2. Grammatico-Guillon, L, Rusch, E, Astagneau, P. Surveillance of prosthetic joint infections: international overview and new insights for hospital databases. J Hosp Infect 2015;89:90–98.Google Scholar
3. Lamagni, T. Epidemiology and burden of prosthetic joint infections. J Antimicrob Chemother 2014;69:i5–i10.CrossRefGoogle ScholarPubMed
4. Peel, TN, Cheng, AC, Liew, D, et al. Direct hospital cost determinants following hip and knee arthroplasty. Arthritis Care Res 2015;67:782–790.Google Scholar
5. Grammatico-Guillon, L, Baron, S, Rosset, P, et al. Surgical site infection after primary hip and knee arthroplasty: a cohort study using a hospital database. Infect Control Hosp Epidemiol 2015;36:1198–1207.Google Scholar
6. Weigelt, JA, Lipsky, BA, Tabak, YP, Derby, KG, Kim, M, Gupta, V. Surgical site infections: causative pathogens and associated outcomes. Am J Infect Control 2010;38:112–120.CrossRefGoogle ScholarPubMed
7. Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725–730.Google Scholar
8. Coello, R, Charlett, A, Wilson, J, Ward, V, Pearson, A, Borriello, P. Adverse impact of surgical site infections in English hospitals. J Hosp Infect 2005;60:93–103.Google Scholar
9. Zmistowski, B, Karam, JA, Durinka, JB, et al. Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am 2013;95:2177–2184.Google Scholar
10. Cahill, JL, Shadbolt, B, Scarvell, JM, et al. Quality of life after infection in total joint replacement. J Orthop Surg (Hong Kong) 2008;16:58–65.Google Scholar
11. Gaynes, R, Richards, C, Edwards, J, et al. Feeding back surveillance data to prevent hospital-acquired infections. Emerg Infect Dis 2001;7:295–298.CrossRefGoogle ScholarPubMed
12. Sykes, PK, Brodribb, RK, McLaws, ML, McGregor, A. When continuous surgical site infection surveillance is interrupted: the Royal Hobart Hospital experience. Am J Infect Control 2005;33:422–427.CrossRefGoogle ScholarPubMed
13. Wilson, J. Surveillance of surgical site infection in orthopaedic surgery is useful in tackling hospital-acquired infections in England. Euro Surveill 2005;10:E051117.3.Google Scholar
14. Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.Google Scholar
15. Condon, RE, Schulte, WJ, Malangoni, MA, Anderson-Teschendorf, MJ. Effectiveness of a surgical wound surveillance program. Arch Surg 1983;118:303–307.CrossRefGoogle ScholarPubMed
16. Delgado-Rodriguez, M, Gomez-Ortega, A, Sillero-Arenas, M, Martinez-Gallego, G, Medina-Cuadros, M, Llorca, J. Efficacy of surveillance in nosocomial infection control in a surgical service. Am J Infect Control 2001;29:289–294.CrossRefGoogle Scholar
17. Gastmeier, P, Brauer, H, Forster, D, Dietz, E, Daschner, F, Ruden, H. A quality management project in 8 selected hospitals to reduce nosocomial infections: a prospective, controlled study. Infect Control Hosp Epidemiol 2002;23:91–97.CrossRefGoogle ScholarPubMed
18. Centers for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN). Surgical site infection (SSI) event. Procedure-associated module SSI. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf. Published January 2016. Accessed May 16, 2016.Google Scholar
19. Koek, MB, Wille, JC, Isken, MR, Voss, A, van Benthem, BH. Post-discharge surveillance (PDS) for surgical site infections: a good method is more important than a long duration. Euro Surveill 2015;20 pii:21042. Eurosurveillance website. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21042. Accessed May 19, 2016.Google ScholarPubMed
20. Dicks, KV, Lewis, SS, Durkin, MJ, et al. Surveying the surveillance: surgical site infections excluded by the January 2013 updated surveillance definitions. Infect Control Hosp Epidemiol 2014;35:570–573.Google Scholar
21. Yokoe, DS, Avery, TR, Platt, R, Huang, SS. Reporting surgical site infections following total hip and knee arthroplasty: impact of limiting surveillance to the operative hospital. Clin Infect Dis 2013;57:1282–1288.CrossRefGoogle Scholar
22. Ong, KL, Kurtz, SM, Lau, E, et al. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplasty 2009;24:105–109.Google Scholar
23. Kurtz, SM, Ong, KL, Lau, E, Bozic, KJ, Berry, D, Parvizi, J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res 2010;468:52–56.CrossRefGoogle ScholarPubMed
24. Davies, BM, Patel, HC. Letter to the editor: Is a reduced duration of post-discharge surgical site infection surveillance really in our best interests? Euro Surveill 2015;20:42.Google Scholar
25. Rutledge-Taylor, K, Mitchell, R, Pelude, L, AbdelMalik, P, Roth, V. Evaluation of the representativeness of the Canadian Nosocomial Infection Surveillance Program. Can J Infect Control 2015;30:13–15.Google Scholar
26. Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;91:152S–157S.Google Scholar
27. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
28. Annual Epidemiological Report: Antimicrobial Resistance and Healthcare-associated Infections. 2014. European Center for Disease Prevention and Control website. http://ecdc.europa.eu/en/publications/Publications/antimicrobial-resistance-annual-epidemiological-report.pdf. Published April 2015. Accessed May 16, 2016.Google Scholar
29. Rosenthal, VD, Richtmann, R, Singh, S, et al. Surgical site infections, International Nosocomial Infection Control Consortium (INICC) report, data summary of 30 countries, 2005–2010. Infect Control Hosp Epidemiol 2013;34:597–604.Google Scholar
30. National and State Healthcare Associated Infections (HAI) Progress Report. (2012 data). Centers for Disease Control and Prevention website. http://www.cdc.gov/HAI/pdfs/progress-report/hai-progress-report-2014.pdf. Published March 2014. Accessed May 16, 2016.Google Scholar
31. Lower, HL, Dale, H, Eriksen, HM, Aavitsland, P, Skjeldestad, FE. Response to letter to the editor regarding: “Surgical site infections after hip arthroplasty in Norway, 2005–2011: Influence of duration and intensity of postdischarge surveillance.” Am J Infect Control 2015;43:1024–1025.CrossRefGoogle Scholar
32. Healthcare Infection Control Practices Advisory Committee (HICPAC). Meeting summary report. June 14–15, 2012, Atlanta, GA. Centers for Disease Control and Prevention website. http://www.cdc.gov/hicpac/pdf/mm/HICPAC-MEETING-MINUTES-JUNE-2012.pdf. Published 2012. Accessed May 16, 2016.Google Scholar
33. Koek, MB. Authors response: Is a reduced duration of post-discharge surgical site infection surveillance really in our best interests? Euro Surveill 2015;20:43.Google ScholarPubMed
34. Surveillance of Surgical Site Infections in NHS Hospitals in England 2014/15. Public Health England website. https://www.gov.uk/government/publications/surgical-site-infections-ssi-surveillance-nhs-hospitals-in-england. Published December 2015. Accessed May 19, 2016.Google Scholar
35. Peel, TN, Cheng, AC, Buising, KL, Choong, PF. Microbiological aetiology, epidemiology, and clinical profile of prosthetic joint infections: are current antibiotic prophylaxis guidelines effective? Antimicrob Agents Chemother 2012;56:2386–2391.CrossRefGoogle ScholarPubMed
36. Kapadia, BH, McElroy, MJ, Issa, K, Johnson, AJ, Bozic, KJ, Mont, MA. The economic impact of periprosthetic infections following total knee arthroplasty at a specialized tertiary-care center. J Arthroplasty 2014;29:929–932.CrossRefGoogle Scholar