Study: Staphylococcus aureus infections following knee and hip prosthesis insertion procedures

June 9, 2015
Staphylococcus aureus infections following knee and hip prosthesis insertion procedures
From the Antimicrobial Resistance and Infection Control

The impact of surgical site infections (SSIs) following prosthesis procedures is devastating, often leading to higher mortality, prolonged hospitalizations, frequent readmissions, and increased costs and overall healthcare burden. According to the United States (US) National Healthcare Safety Network (NHSN), SSI rates following total knee or hip arthroplasty procedures performed from January 1, 2006 through December 31, 2008 ranged from 0.60 to 1.60 and 0.7 to 2.4 per 100 procedures, respectively, depending on patient risk level. Common factors between knee and hip procedures found to be associated with increased risk for deep incisional or organ/space SSIs include younger age, revision procedures, longer procedure duration, severity of underlying illness, hospital affiliation with a medical school, bed size >200, and trauma.

The prevalence of postoperative invasive Staphylococcus aureus and methicillin-resistantStaphylococcus aureus infections in patients who have undergone knee or hip prostheses was examined in a recent study.

Researchers conducted a nested retrospective cohort analysis that included adult patients who had undergone insertion of knee or hip prostheses with clean or clean-contaminated wound class at 11 hospitals between 2003 and 2006. After each procedure, the researchers identified invasive S. aureus infections, surgical site infections and bloodstream infections.

Findings from the study included:

1. Out of more than 13,000 procedures, researchers identified 92 S. aureus infections.

2. Surgical site infections were the most common (80 percent) type of S. aureus infections, with significantly higher prevalence than bloodstream S. aureus infections (10 percent) or surgical site and bloodstream infections combined (10 percent).

3. Of 82 total post-operative infections in patients undergoing prosthetic hip insertion, 44 (54%) were invasive S. aureus infections.

4. More than half (53 percent) of the S. aureus infections were classified as MRSA.

5. The median time-to-onset of infection was 34 days for knee insertion and 26 days for hip insertion.

The conclusions of the study found that post-operative invasive S. aureus infections were rare, but difficult-to-treat methicillin-resistant infections were relatively common. Optimizing preventative efforts may greatly reduce the healthcare burden associated with S. aureus infections.



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