Debreuve-Theresette Adeline, Diallo Saidou, Siboni Renaud, Ohl Xavier, Dehoux Emile, Bajolet Odile
1 Equipe Opérationnelle d'Hygiène, Laboratoire de Bactériologie-Virologie-Hygiène, Centre Hospitalier Universitaire de Reims , Reims, France .
2 Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Universitaire de Reims , Reims, France .
Surg Infect (Larchmt). 2015 Dec;16(6):794-8. doi: 10.1089/sur.2014.155. Epub 2015 Aug 10.
Surgical site infections (SSI) are a dreaded complication of total hip (THA) and knee arthroplasties (TKA), and are a major public health concern. Risk factors are well known, but no endogenous risk assessment score exists. The objective of this study to develop a score to assess endogenous risk of infection after THA or TKA.
All infections after TKA and THA implanted in the department of orthopedic surgery of a teaching hospital between January 2007 and December 2012 were included. Two control groups were matched to cases on the type of prosthesis (hip or knee; first-line or revision).
Twenty-four SSIs after THA and 21 after TKA were registered (respective incidence during the study period: 1.56 and 1.91%). Relevant endogenous risk factors found were: Smoking (adjusted odds ratio=3.9), a BMI greater than 35 kg/mÇ (1.8), inflammatory rheumatism (7.3), and the number of operations (prosthetic or not) on the involved joint (2.9 per additional surgery). The average score of endogenous infection risk on all analyzed subjects was 3.37±3.33 (median=3, range=0-17). Mean scores were substantially different among cases and control groups: Respectively 5.84±4.04 vs 2.13±2.01 (p<0.0001). With a five-point threshold, the sensitivity and specificity of the score are respectively 62 and 91%. ASA score greater than or equal to three was not found to be substantial risk factor in this study (p=0.15).
Endogenous infection risk score studied here was found to be relevant in discriminating cases from control groups, but requires validation in a larger cohort.
手术部位感染（SSI）是全髋关节置换术（THA）和膝关节置换术（TKA）令人恐惧的并发症，也是一个主要的公共卫生问题。危险因素众所周知，但尚无内源性风险评估评分。本研究的目的是制定一个评分系统，以评估THA或TKA术后的内源性感染风险。
纳入2007年1月至2012年12月间在一家教学医院骨科植入TKA和THA后的所有感染病例。两个对照组在假体类型（髋关节或膝关节；一线或翻修）上与病例匹配。
记录到THA术后24例SSI，TKA术后21例（研究期间的发病率分别为1.56%和1.91%）。发现的相关内源性危险因素有：吸烟（调整比值比=3.9）、体重指数大于35kg/m²（1.8）、炎性风湿病（7.3）以及受累关节的手术次数（假体或非假体手术）（每增加一次手术为2.9）。所有分析对象的内源性感染风险平均评分为3.37±3.33（中位数=3，范围=0-17）。病例组和对照组的平均评分有显著差异：分别为5.84±4.04和2.13±2.01（p<0.0001）。以五分阈值计算，该评分的敏感性和特异性分别为62%和91%。在本研究中，未发现美国麻醉医师协会（ASA）评分大于或等于3是一个重要危险因素（p=0.15）。
本研究中的内源性感染风险评分在区分病例组和对照组方面具有相关性，但需要在更大的队列中进行验证。
