Tekin-Taş Zeynep, Özger Hasan Selçuk, Kanatlı Ulunay, Hızel Kenan
Department of Infectious Disease and Clinical Microbiology, Gazi University School of Medicine, Ankara, Türkiye.
Department of Orthopaedics and Traumatology, Gazi University School of Medicine, Ankara, Türkiye.
Infect Dis Clin Microbiol. 2024 Jun 28;6(2):93-101. doi: 10.36519/idcm.2024.332. eCollection 2024 Jun.
Periprosthetic joint infections (PJI) represent major complications in arthroplasty, contributing to increased patient morbidity and imposing substantial financial burdens. Meticulous surveillance of PJI occurrences and identification of associated risk factors is imperative for accurately gauging the incidence rates and implementing proactive infection control measures. This study aimed to ascertain the early incidence of PJI and elucidate the key risk factors involved in its occurrence.
This monocentric, prospective descriptive study conducted between June 2018 and June 2019, including all patients aged 18 years and above who underwent hip and knee arthroplasty. The research documented and evaluated patient demographic characteristics, clinical findings, laboratory results, treatment practices, and potential risk factors associated with the surgical process. After the 90-day postoperative period, patients were categorized into PJI and non-PJI groups, allowing for a comprehensive comparison of identified risk factors.
This study identified a cohort of 590 patients, of whom 185 underwent hip arthroplasties (31.4%) and 405 underwent knee arthroplasties (68.6%). The average age of the patients was 65.2 years, with females constituting 80.2% of the population. The overall incidence of early PJI was found to be 2.88% (n=17). Following hip arthroplasties, the PJI incidence was 4.86%, while knee arthroplasties exhibited a lower incidence of 1.9%. Several potential risk factors associated with PJI were identified, including comorbid diseases (adjusted odds ratio [aOR]=3.35, 95% confidence interval [CI]=1.18-9.47), preoperative length of stay (aOR=0.89, 95% CI=0.79-1.01), postoperative erythrocyte suspension replacement (aOR=1.96, 95% CI=0.71-5.44), and a National Nosocomial Infections Surveillance System (NNIS) score of 1 or higher (aOR=3.10, 95% CI=1.10-8.71). These factors were identified as potential contributors to the risk of PJI in patients undergoing hip and knee arthroplasties.
Compared to other reported outcomes in the literature, this study observed a higher incidence of early-stage PJI. The higher incidence may be due to PJI surveillance deficiencies such as difficulty in post-discharge surgical site infection (SSI) follow-up, reporting, and bacterial sampling. This discrepancy underscores the importance of actively monitoring patients with risk factors for PJI development, including medical comorbidities and a high NNIS score. Implementing prospective active surveillance in such cases is deemed crucial for the timely identification and management of PJI.
人工关节周围感染（PJI）是关节置换术中的主要并发症，会增加患者的发病率，并带来沉重的经济负担。对PJI的发生情况进行细致监测并识别相关风险因素，对于准确评估发病率以及实施积极的感染控制措施至关重要。本研究旨在确定PJI的早期发病率，并阐明其发生的关键风险因素。
本单中心前瞻性描述性研究于2018年6月至2019年6月进行，纳入所有年龄在18岁及以上接受髋膝关节置换术的患者。研究记录并评估了患者的人口统计学特征、临床发现、实验室检查结果、治疗方法以及与手术过程相关的潜在风险因素。术后90天之后，将患者分为PJI组和非PJI组，以便对识别出的风险因素进行全面比较。
本研究共纳入590例患者，其中185例行髋关节置换术（31.4%），405例行膝关节置换术（68.6%）。患者的平均年龄为65.2岁，女性占80.2%。早期PJI的总体发病率为2.88%（n = 17）。髋关节置换术后，PJI发病率为4.86%，而膝关节置换术的发病率较低，为1.9%。识别出了几个与PJI相关的潜在风险因素，包括合并症（调整优势比[aOR]=3.35，95%置信区间[CI]=1.18 - 9.47）、术前住院时间（aOR=0.89，95% CI=0.79 - 1.01）、术后红细胞悬液输注（aOR=1.96，95% CI=0.71 - 5.44）以及国家医院感染监测系统（NNIS）评分为1分或更高（aOR=3.10，95% CI=1.10 - 8.71）。这些因素被确定为髋膝关节置换术患者发生PJI风险的潜在因素。
与文献中其他报道的结果相比，本研究观察到早期PJI的发病率较高。较高的发病率可能是由于PJI监测存在缺陷，如出院后手术部位感染（SSI）的随访、报告和细菌采样困难。这种差异强调了积极监测有PJI发生风险因素的患者的重要性，这些因素包括合并症和高NNIS评分。在这些情况下实施前瞻性主动监测对于及时识别和管理PJI至关重要。
