Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona.
J Arthroplasty. 2024 Sep;39(9S2):S444-S448.e1. doi: 10.1016/j.arth.2024.03.058. Epub 2024 Mar 26.
Periprosthetic joint infection (PJI) following total hip arthroplasty (THA) is associated with major morbidity. There may be a link between the gut microbiome and an individual's overall immune system. A Clostridium difficile (C. difficile) infection portends poor gut microbiome health and has been previously associated with increased 90-day complication rates in total joint arthroplasty (TJA). The purpose of this study was to determine the effect of a previous history of C. difficile infection within 2 years of undergoing THA on PJI within 2 years postoperatively.
Patients undergoing THA from 2010 to 2021 were identified in a patient claims database (n = 770,075). Patients who had active records 2 years before and after THA as well as a history of C. difficile infection within 2 years prior to THA (n = 1,836) were included and propensity matched to a control group using age, sex, and Elixhauser comorbidity index. The primary outcome was the 2-year incidence of postoperative PJI. The exposed C. difficile infection cohort was stratified into 4 groups based on the time proximity of the C. difficile infection. Chi-square tests and logistic regressions were used to compare the groups.
A C. difficile infection anytime within 2 years prior to total hip arthroplasty was independently associated with higher odds of PJI (OR [odds ratio]: 1.49 [95% CI (confidence interval) 1.09 to 2.02, P = .014]). Proximity of C. difficile infection to arthroplasty was associated with increased risk of PJI (infection 0 to 3 months before THA: OR 2.01 [95% CI 1.23 to 3.20], infection 3 to 6 months before THA: OR 1.84 [95% CI 1.06 to 3.04], infection 6 to 12 months before THA: OR 1.10 [95% CI 0.65 to 1.77], infection 1 to 2 years before THA: OR 1.40 [95% CI 0.94 to 2.06]).
A C. difficile infection prior to THA is an independent risk factor for PJI. Proximity of C. difficile infection is associated with increased risk of PJI. Future investigations should evaluate how to adequately optimize patients prior to THA and pursue strategies to determine appropriate timing for proceeding with THA.
全髋关节置换术后（THA）发生的假体周围关节感染（PJI）与严重发病率相关。肠道微生物组与个体的整体免疫系统之间可能存在联系。艰难梭菌（C. difficile）感染预示着肠道微生物组健康状况不佳，先前与全关节置换术（TJA）的 90 天并发症发生率增加有关。本研究的目的是确定在接受 THA 前 2 年内有 C. difficile 感染史对术后 2 年内 PJI 的影响。
从患者索赔数据库中确定了 2010 年至 2021 年期间接受 THA 的患者（n=770075）。在 THA 前后 2 年有活动记录且在 THA 前 2 年内有 C. difficile 感染史的患者（n=1836）被纳入并使用年龄、性别和 Elixhauser 合并症指数进行倾向匹配以纳入对照组。主要结局是术后 2 年 PJI 的发生率。根据 C. difficile 感染的时间接近程度，将暴露于 C. difficile 感染的队列分为 4 组。使用卡方检验和逻辑回归比较各组。
THA 前 2 年内任何时候的 C. difficile 感染与 PJI 的几率更高独立相关（比值比[OR]：1.49[95%置信区间（CI）1.09 至 2.02，P=0.014]）。C. difficile 感染与关节置换术的接近程度与 PJI 的风险增加相关（THA 前 0 至 3 个月的感染：OR 2.01[95%CI 1.23 至 3.20]，THA 前 3 至 6 个月的感染：OR 1.84[95%CI 1.06 至 3.04]，THA 前 6 至 12 个月的感染：OR 1.10[95%CI 0.65 至 1.77]，THA 前 1 至 2 年的感染：OR 1.40[95%CI 0.94 至 2.06]）。
THA 前的 C. difficile 感染是 PJI 的独立危险因素。C. difficile 感染的接近程度与 PJI 的风险增加相关。未来的研究应评估如何在 THA 前充分优化患者，并寻求确定进行 THA 适当时间的策略。
