Preoperative and perioperative risk factors, and risk score development for prosthetic joint infection due to Staphylococcus aureus: a multinational matched case-control study. (October 2022)

• Record Type: Journal Article
• Authors: Espindola, Reinaldo; Vella, Venanzio; Benito, Natividad; Mur, Isabel; Tedeschi, Sara; Rossi, Nicolò; Hendriks, Johannes G.E.; Sorlí, Luisa; Murillo, Oscar; Scarborough, Mathew; Scarborough, Claire; Kluytmans, Jan; Ferrari, Mateo Carlo; Pletz, Mathias W.; Mcnamara, Iain; Escudero-Sanchez, Rosa; Arvieux, Cedric; Batailler, Cecile; Dauchy, Frédéric-Antoine; Liu, Wai-Yan; Lora-Tamayo, Jaime; Praena, Julia; Ustianowski, Andrew; Cinconze, Elisa; Pellegrini, Michele; Bagnoli, Fabio; Rodríguez-Baño, Jesús; Del Toro, Maria Dolores; Cuperus, Nienke; Manfré, Giuseppe; Zamparini, Eleonora; Verhagen, Stéphanie; Horcajada, Juan P.; Junyent, Joan Gómez; Alier, Albert; Soldevila, Laura; van Rijen, Miranda; Romme, Jannie; Ankert, Juliane; Whitehouse, Celia; Jones, Adrian; Cobo, Javier; Moreno, Javier; Meheut, Anne; Gledel, Claire; Perreau, Pauline; van Wensen, Remco J.A.; Lindergard, Gabriella;
• Is Part Of: Clinical microbiology and infection. Volume 28:Number 10(2022)
• Page Start: 1359
• Page End: 1366
• Publication Date: 2022-10
• Subjects: Prosthetic joint infection -- Arthroplasty -- Staphylococcus aureus -- Risk factors -- Case-control study -- Multinational study; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2022.05.010
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: Objectives: We aim to identify the preoperative and perioperative risk factors associated with post-surgical Staphylococcus aureus prosthetic joint infections (PJI) and to develop and validate risk-scoring systems, to allow a better identification of high-risk patients for more efficient targeted interventions. Methods: We performed a multicenter matched case-control study of patients who underwent a primary hip and knee arthroplasty from 2014 to 2016. Two multivariable models by logistic regression were performed, one for the preoperative and one for perioperative variables; predictive scores also were developed and validated in an external cohort. Results: In total, 130 cases and 386 controls were included. The variables independently associated with S. aureus -PJI in the preoperative period were (adjusted OR; 95% CI): body mass index >30 kg/m 2 (3.0; 1.9 to 4.8), resident in a long-term care facility (2.8; 1.05 to 7.5), fracture as reason for arthroplasty (2.7; 1.4 to 5.03), skin disorders (2.5; 0.9 to 7.04), previous surgery in the index joint (2.4; 1.3 to 4.4), male sex (1.9; 1.2 to 2.9) and American Society of Anesthesiologists index score 3 to 4 (1.8; 1.2 to 2.9). The area under the receiver operating characteristic curve was 0.73 (95% CI 0.68 to 0.78). In perioperative model, the risk factors were the previous ones plus surgical antibiotic prophylaxis administered out of the first 60 minutes before incision (5.9; 2.1 to 16.2), wound drainage for >72 hours after arthroplasty (4.5; 1.9 to 19.4) and use of metal bearing material versus ceramic (1.9; 1.1 to 3.3). The area under the receiver operating characteristic curve was 0.78 (95% CI 0.72 to 0.83). The predictive scores developed were validated in the external cohort. Discussion: Predictive scores for S. aureus -PJI were developed and validated; this information would be useful for implementation of specific preventive measures.