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Prosthetic Joint An infection Most Doubtless Inside First 12 months of Whole Knee Arthroplasty

Prosthetic joint injections (PJIs) are most definitely to happen inside the preliminary 12 months following whole knee arthroplasty (TKA), in response to research outcomes printed in JAMA Community Open.

Researchers on the College of Pennsylvania carried out a retrospective cohort research to judge the incidence and danger elements of postoperative PJIs amongst sufferers who underwent TKA. Affected person knowledge had been sourced from the Veterans Affairs (VA) Company Information Warehouse, together with demographic traits, medical diagnoses, procedures, microbiological tradition and laboratory outcomes, and prescribed medicines. Sufferers (N=79,367) had been included in the event that they underwent elective major TKA between 1999 and 2019 and had obtained care on the VA for a minimum of 1 12 months.

The first endpoint was incident hospitalization for PJI. The incidence of PJIs (per 10,000 person-months) was in contrast between 3 postoperative durations, together with early (≤3 months), delayed (>3 to ≤12 months), and late (<12 months) PJI prevalence. To find out PJI danger elements for every postoperative interval, the researchers used a piecewise exponential parametric survival mannequin match by Poisson regression. Inside every interval, the frequencies of gram-positive, gram-negative, fungal, polymicrobial, and culture-negative PJIs had been in contrast utilizing chi-square testing.

Among the many research inhabitants, the median affected person age was 65 (IQR, 60-71) years, most had been males (94.8%), and most had been non-Hispanic White (73.5%).


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The researchers famous a complete of 1599 incident PJIs, of which 627 (39.2%) occurred within the early, 356 (22.2%) within the delayed, and 616 (38.5%) within the late postoperative interval. The incidence of PJIs was greater within the early (incidence price ratio [IRR]26.8; 95% CI, 24.8-29.0) and delayed (IRR, 5.4; 95% CI, 4.9-6.0, respectively) durations than within the late interval (IRR, 1.3; 95% CI, 1.201.4).

Total, 164 PJIs had been gram-negative and 710 had been gram-positive. Essentially the most generally remoted pathogen for gram-positive and gram-negative PJIs was Staphylococcus aureus and Enterobacterrespectively. As well as, the speed of gram-negative PJIs was greater within the early postoperative interval than within the delayed and late durations mixed (15.4% vs 8.5%, respectively; P <.001).

In all postoperative durations, vital danger elements for incident PJI included hepatitis C virus an infection, peripheral artery illness, and autoimmune inflammatory arthritis. Important danger elements had been additionally famous for particular person postoperative durations, together with autoimmune inflammatory arthritis for early PJIs (adjusted IRR [aIRR]2.3; 95% CI, 1.5-3.5), excessive BMI (≥40 kg/m2) for delayed PJIs (aIRR, 2.7; 95% CI, 1.5-4.9), and anemia for late PJIs (aIRR, 2.2; 95% CI, 1.5-3.1).

Examine limitations embody doubtlessly misclassified PJI outcomes, the predominance of males, the shortage of information on comorbidity severity, and the potential for residual confounding.

In response to the researchers, “[E]mpirical gram-negative antibiotic therapy should be considered along with the usual gram-positive coverage for early PJIs.”

Disclosures: A number of research authors declared affiliations with biotech, pharmaceutical, and/or system corporations. Please see the unique reference for a full listing of disclosures.

Reference

Weinstein EJ, Stephens-Shields AJ, Newcomb CW, et al. Incidence, microbiological research, and elements related to prosthetic joint an infection after whole knee arthroplasty. JAMA Netw Open. 2023;6(10):e2340457. doi:10.1001/jamanetworkopen.2023.40457

This text initially appeared on Infectious Illness Advisor

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