Cadera/Hip/Hüfte/Hanche: Crece la resistencia de algunos estafilococos

Increasing Resistance of Coagulase-Negative Staphylococci in Total Hip Arthroplasty Infections: 278 THA-Revisions due to Infection Reported to the Norwegian Arthroplasty Register from 1993 to 2007
Olav Lutro, Håkon Langvatn, Håvard Dale, Johannes Cornelis Schrama, Geir Hallan, Birgitte Espehaug, Haakon Sjursen, Lars B Engesæter
Adv Orthop. 2014;2014:580359. doi: 10.1155/2014/580359. Epub 2014 Oct 9.

We investigated bacterial findings from intraoperative tissue samples taken during revision due to infection after total hip arthroplasty (THA). The aim was to investigate whether the susceptibility patterns changed during the period from 1993 through 2007.

Reported revisions due to infection in the Norwegian Arthroplasty Register (NAR) were identified, and 10 representative hospitals in Norway were visited. All relevant information on patients reported to the NAR for a revision due to infection, including bacteriological findings, was collected from the medical records.

A total of 278 revision surgeries with bacterial growth in more than 2 samples were identified and included. Differences between three 5-year time periods were tested by the chi-square test for linear trend. The most frequent isolates were coagulase-negative staphylococci (CoNS) (41%, 113/278) and Staphylococcus aureus (19%, 53/278). The proportion of CoNS resistant to the methicillin-group increased from 57% (16/28) in the first period, 1993-1997, to 84% (52/62) in the last period, 2003-2007 (P = 0.003). There was also significant increase in resistance for CoNS to cotrimoxazole, quinolones, clindamycin, and macrolides. All S. aureus isolates were sensitive to both the methicillin-group and the aminoglycosides. For the other bacteria identified no changes in susceptibility patterns were found.

General: No se infectan las protesis por infiltrar antes la articulación

Do Intra-Articular Steroid Injections Increase Infection Rates in Subsequent Arthroplasty? A Systematic Review and Meta-Analysis of Comparative Studies

Charalambos P. Charalambous, Apostolos D. Prodromidis, Tariq A. Kwaees

J of Arthroplasty Published Online: August 02, 2014

Abstract

Intra-articular steroid injections are widely used in joint arthritis. The safety of such injections has been questioned as they may increase infection rates in subsequent arthroplasty. We carried out a meta-analysis of studies examining the relation between intra-articular steroid injections and infection rates in subsequent joint arthroplasty. A literature search was undertaken. Eight studies looking at hip and knee arthroplasties were analyzed. Meta-analysis showed that steroid injection had no significant effect on either deep (risk ratio = 1.87; 95% CI 0.80–4.35; P = 0.15) or superficial infection rates (risk ratio = 1.75; 95% CI 0.76–4.04; P = 0.19) of subsequent arthroplasty. Further large cohort studies would be of value in further examining whether steroid injections close to the time of arthroplasty are safe.

Rodilla/Knee/Knie: Hay que evitar la PTR en verano

Seasonality of infection rates after total joint arthroplasty.

Kane P, Chen C, Post Z, Radcliff K, Orozco F, Ong A

Orthopedics February 2014 - Volume 37 · Issue 2: e182-e186

Abstract

The correlation between season (fall, winter, spring, and summer) and infection rate in surgical patients is well defined in many specialties. To the authors' knowledge, there are no data in the literature on this phenomenon in patients undergoing total joint arthroplasty. They hypothesized that there would be an increased infection rate in the summer months in patients undergoing elective total joint arthroplasty. They retrospectively reviewed consecutive patients undergoing elective total hip or knee arthroplasty at a single institution during 1 year by a single surgeon. Wound infections were defined as any patient requiring oral antibiotics for cellulitis, readmission for intravenous antibiotics, a return to the operating room for irrigation and debridement, or excisional arthroplasty and placement of a cement spacer within 90 days of the initial procedure. Seventeen of 750 patients developed an infection, for an overall incidence of 2.2%. There was a statistically significant difference in infection rate according to season: 3 (1.5%) infections occurred in winter, 1 (0.5%) in spring, 9 (4.7%) in summer, and 4 (2.4%) in fall. The incidence was highest during July (4.5%), August (5.4%), and September (4.3%). There was a statistically significant difference in infection rate between summer/fall (3.6%) vs winter/spring (1.0%). There is an increase in the incidence of infection during summer months for patients undergoing total joint arthroplasty. The authors recommend increased surveillance and more thorough preoperative sterilization procedures during these warmer months

Trauma: ¿evitar los AINES en las fracturas de huesos largos?

Nonsteroidal anti-inflammatory drugs’ impact on nonunion and infection rates in long-bone fractures

Jeffcoach, David R. MD; Sams, Valerie G. MD; Lawson, Christy M. MD; Enderson, Blaine L. MD, MBA; Smith, Scott T. MD; Kline, Heather PA-C; Barlow, Patrick B. BA; Wylie, Douglas R. PharmD; Krumenacker, Laura A. PharmD; McMillen, James C. PharmD; Pyda, Jordan BS; Daley, Brian J. MD, MBA ; University of Tennessee Medical Center, Department of Surgery

Journal of Trauma and Acute Care Surgery. 76(3):779-783, March 2014.

Abstract

BACKGROUND

There is a dearth of clinical data regarding the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on long-bone fracture (LBF) healing in the acute trauma setting. The orthopedic community believes that the use of NSAIDs in the postoperative period will result in poor healing and increased infectious complications. We hypothesized that, first, NSAID use would not increase nonunion/malunion and infection rates after LBF. Second, we hypothesized that tobacco use would cause higher rates of these complications.

METHODS

A retrospective study of all patients with femur, tibia, and/or humerus fractures between October 2009 and September 2011 at a Level 1 academic trauma center was performed . In addition to nonunion/malunion and infection rates, patient records were reviewed for demographic data, mechanism of fracture, type of fracture, tobacco use, Injury Severity Score (ISS), comorbidities, and medications given.

RESULTS

During the 24-month period, 1,901 patients experienced LBF; 231 (12.1%) received NSAIDs; and 351 (18.4%) were smokers. The overall complication rate including nonunion/malunion and infection was 3.2% (60 patients). Logistic regression analysis with adjusted odds ratios were calculated on the risk of complications given NSAID use and/or smoking, and we found that a patient is significantly more likely to have a complication if he or she received an NSAID (odds ratio, 2.17; 95% confidence interval, 1.15–4.10; p < 0.016) in the inpatient postoperative setting. Likewise, smokers are significantly more likely to have complications (odds ratio, 3.19; 95% confidence interval, 1.84–5.53; p < 0.001).

CONCLUSION

LBF patients who received NSAIDs in the postoperative period were twice as likely and smokers more than three times likely to suffer complications such as nonunion/malunion or infection. We recommend avoiding NSAID in traumatic LBF.

LEVEL OF EVIDENCE

Epidemiologic & therapeutic study; level II

Rodilla y cadera /Joint: perder peso antes de la artroplastia

The Impact of Pre-Operative Weight Loss on Incidence of Surgical Site Infection and Readmission Rates After Total Joint Arthroplasty

Maria C.S. Inacio, PhD, Donna Kritz-Silverstein, PhD, Rema Raman, PhD, Caroline A. Macera, PhD, Jeanne F. Nichols, PhD, Richard A. Shaffer, PhD, Donald C. Fithian, MD

J Arthroplasty Volume 29, Issue 3 , Pages 458-464.e1, March 2014

Published online 09 September 2013.

Abstract 

This study characterized a cohort of obese total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients (1/1/2008–12/31/2010) and evaluated whether a clinically significant amount of pre-operative weight loss (5% decrease in body weight) is associated with a decreased risk of surgical site infections (SSI) and readmissions post-surgery. 10,718 TKAs and 4066 THAs were identified. During the one year pre-TKA 7.6% of patients gained weight, 12.4% lost weight, and 79.9% remained the same. In the one year pre-THA, 6.3% of patients gained weight, 18.0% lost weight, and 75.7% remained the same. In TKAs and THAs, after adjusting for covariates, the risk of SSI and readmission was not significantly different in the patients who gained or lost weight pre-operatively compared to those who remained the same.