Department of Orthopedics, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
BMJ Open. 2024 Apr 29;14(4):e076576. doi: 10.1136/bmjopen-2023-076576.
Prosthetic joint infection (PJI) is a serious complication following total hip arthroplasty (THA) entailing increased mortality, decreased quality of life and high healthcare costs.The primary aim was to investigate whether the national project: Prosthesis Related Infections Shall be Stopped (PRISS) reduced PJI incidence after primary THA; the secondary aim was to evaluate other possible benefits of PRISS, such as shorter time to diagnosis.
Cohort study.
In 2009, a nationwide, multidisciplinary infection control programme was launched in Sweden, PRISS, which aimed to reduce the PJI burden by 50%.
We obtained data on patients undergoing primary THA from the Swedish Arthroplasty Registry 2012-2014, (n=45 723 patients, 49 946 THAs). Using personal identity numbers, this cohort was matched with the Swedish Prescribed Drug Registry. Medical records of patients with ≥4 weeks' antibiotic consumption were reviewed to verify PJI diagnosis (n=2240, 2569 THAs).
The cumulative incidence of PJI following the PRISS Project was 1.2% (95% CI 1.1% to 1.3%) as compared with 0.9% (95% CI 0.8% to 1.0%) before. Cox regression models for the PJI incidence post-PRISS indicates there was no statistical significance difference versus pre-PRISS (HR 1.1 (95% CI 0.9 to 1.3)). There was similar time to PJI diagnosis after the PRISS Project 24 vs 23 days (p=0.5).
Despite the comprehensive nationwide PRISS Project, Swedish PJI incidence was higher after the project and time to diagnosis remained unchanged. Factors contributing to PJI, such as increasing obesity, higher American Society of Anesthesiology class and more fractures as indications, explain the PJI increase among primary THA patients.
人工关节感染（PJI）是全髋关节置换术（THA）后的一种严重并发症，可导致死亡率增加、生活质量下降和医疗保健费用增加。主要目的是调查国家项目：停止假体相关感染（PRISS）是否会降低初次 THA 后的 PJI 发生率；次要目的是评估 PRISS 可能带来的其他益处，例如缩短诊断时间。
队列研究。
2009 年，瑞典启动了一项全国性的多学科感染控制计划 PRISS，旨在将 PJI 负担减少 50%。
我们从瑞典关节置换登记处 2012-2014 年获得了接受初次 THA 的患者数据（n=45723 名患者，49946 例 THA）。使用个人身份号码，该队列与瑞典处方药物登记处相匹配。对接受≥4 周抗生素治疗的患者的病历进行了回顾，以验证 PJI 的诊断（n=2240 名患者，2569 例 THA）。
与 PRISS 项目之前相比，PRISS 项目后 PJI 的累积发生率为 1.2%（95%CI 1.1%至 1.3%），而 PRISS 项目之前为 0.9%（95%CI 0.8%至 1.0%）。PRISS 后 PJI 发生率的 Cox 回归模型表明，与 PRISS 前相比无统计学意义差异（HR 1.1（95%CI 0.9 至 1.3））。PRISS 项目后 PJI 的诊断时间相似，为 24 天和 23 天（p=0.5）。
尽管开展了全面的全国性 PRISS 项目，但瑞典的 PJI 发生率在项目后仍然较高，诊断时间保持不变。导致 PJI 的因素，如肥胖增加、美国麻醉医师协会分类更高以及更多骨折作为适应症，解释了初次 THA 患者 PJI 的增加。
