Preoperative and perioperative risk factors, and risk score development for prosthetic joint infection due to Staphylococcus aureus: a multinational matched case-control study
Reinaldo Espindola
(1)
,
Venanzio Vella
(2)
,
Natividad Benito
(3)
,
Isabel Mur
(3)
,
Sara Tedeschi
(4)
,
Nicolò Rossi
(4)
,
Johannes G.E. Hendriks
,
Luisa Sorlí
(5)
,
Oscar Murillo
(6)
,
Mathew Scarborough
(7)
,
Claire Scarborough
(7)
,
Jan Kluytmans
(8)
,
Mateo Carlo Ferrari
(9)
,
Mathias Pletz
(10)
,
Iain Mcnamara
(11)
,
Rosa Escudero-Sanchez
(12)
,
Cedric Arvieux
(13)
,
Cecile Batailler
(14)
,
Frédéric-Antoine Dauchy
(15)
,
Wai-Yan Liu
(16)
,
Jaime Lora-Tamayo
(17)
,
Julia Praena
(18)
,
Andrew Ustianowski
(19)
,
Elisa Cinconze
(2)
,
Michele Pellegrini
(2)
,
Fabio Bagnoli
(2)
,
Jesús Rodríguez-Baño
(1)
,
Maria Dolores del Toro
(1)
,
Nienke Cuperus
,
Giuseppe Manfré
,
Eleonora Zamparini
,
Stéphanie Verhagen
,
Juan Horcajada
,
Joan Gómez Junyent
,
Albert Alier
,
Laura Soldevila
,
Miranda van Rijen
,
Jannie Romme
,
Juliane Ankert
,
Celia Whitehouse
,
Adrian Jones
,
Javier Cobo
,
Javier Moreno
,
Anne Meheut
,
Claire Gledel
,
Pauline Perreau
,
Remco J.A. van Wensen
,
Gabriella Lindergard
1
Hospital Universitario Virgen Macarena [Séville]
2 GSK - GlaxoSmithKline [Siena, Italy]
3 Hospital de la Santa Creu i Sant Pau
4 UNIBO - Alma Mater Studiorum Università di Bologna = University of Bologna
5 Institut Hospital del Mar d’Investigacions Mèdiques (IMIM)
6 IDIBELL - Institut d'Investigació Biomèdica de Bellvitge = Bellvitge Biomedical Research Institute
7 Oxford University Hospitals NHS Trust
8 AZ=AH - Amphia Ziekenhuis = Amphia Hospital [Breda, The Netherlands]
9 Humanitas Research Hospital
10 Jena University Hospital [Jena]
11 Norfolk and Norwich University Hospital
12 Hospital Universitario Ramón y Cajal [Madrid]
13 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
14 LBMC UMR T9406 - Laboratoire de Biomécanique et Mécanique des Chocs
15 CHU Bordeaux - Centre Hospitalier Universitaire de Bordeaux
16 Catharina Hospital Eindhoven
17 Hospital Universitario Doce de Octubre
18 Hospital Universitario Virgen del Rocío [Sevilla]
19 North Manchester General Hospital
2 GSK - GlaxoSmithKline [Siena, Italy]
3 Hospital de la Santa Creu i Sant Pau
4 UNIBO - Alma Mater Studiorum Università di Bologna = University of Bologna
5 Institut Hospital del Mar d’Investigacions Mèdiques (IMIM)
6 IDIBELL - Institut d'Investigació Biomèdica de Bellvitge = Bellvitge Biomedical Research Institute
7 Oxford University Hospitals NHS Trust
8 AZ=AH - Amphia Ziekenhuis = Amphia Hospital [Breda, The Netherlands]
9 Humanitas Research Hospital
10 Jena University Hospital [Jena]
11 Norfolk and Norwich University Hospital
12 Hospital Universitario Ramón y Cajal [Madrid]
13 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
14 LBMC UMR T9406 - Laboratoire de Biomécanique et Mécanique des Chocs
15 CHU Bordeaux - Centre Hospitalier Universitaire de Bordeaux
16 Catharina Hospital Eindhoven
17 Hospital Universitario Doce de Octubre
18 Hospital Universitario Virgen del Rocío [Sevilla]
19 North Manchester General Hospital
Johannes G.E. Hendriks
- Fonction : Auteur
Nienke Cuperus
- Fonction : Auteur
Giuseppe Manfré
- Fonction : Auteur
Eleonora Zamparini
- Fonction : Auteur
Stéphanie Verhagen
- Fonction : Auteur
Juan Horcajada
- Fonction : Auteur
Joan Gómez Junyent
- Fonction : Auteur
Albert Alier
- Fonction : Auteur
Laura Soldevila
- Fonction : Auteur
Miranda van Rijen
- Fonction : Auteur
Jannie Romme
- Fonction : Auteur
Juliane Ankert
- Fonction : Auteur
Celia Whitehouse
- Fonction : Auteur
Adrian Jones
- Fonction : Auteur
Javier Cobo
- Fonction : Auteur
Javier Moreno
- Fonction : Auteur
Anne Meheut
- Fonction : Auteur
Claire Gledel
- Fonction : Auteur
Pauline Perreau
- Fonction : Auteur
Remco J.A. van Wensen
- Fonction : Auteur
Gabriella Lindergard
- Fonction : Auteur
Résumé
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/m2 (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.