title: The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey.
abstract: The Control of Infection Committee at a specialist orthopaedic hospital prospectively collected data on all episodes of bacteriologically-proven deep infection arising after primary hip and knee replacements over a 15-year period from 1987 to 2001. There were 10 735 patients who underwent primary hip or knee replacement. In 34 of 5947 hip replacements (0.57%) and 41 of 4788 knee replacements (0.86%) a deep infection developed. The most common infecting micro-organism was coagulase-negative staphylococcus, followed by Staphylococcus aureus, enterococci and streptococci. Of the infecting organisms, 72% were sensitive to routine prophylactic antimicrobial agents. Of the infections, 29% (22) arose in the first three months following surgery, 35% between three months and one year (26), and 36% (27) after one year. Most cases were detected early and treated aggressively, with eradication of the infection in 96% (72). There was no significant change in the infection rate or type of infecting micro-organism over the course of this study. These results set a benchmark, and importantly emphasise that only 64% of peri-prosthetic infections arise within one year of surgery. These results also illustrate the advantages of conducting joint replacement surgery in the isolation of a specialist hospital.
authors.affiliation: Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B31 2AP, UK.
authors.forename: J E
authors.initials: JE
authors.lastname: Phillips
authors.forename: T P
authors.initials: TP
authors.lastname: Crane
authors.forename: M
authors.initials: M
authors.lastname: Noy
authors.forename: T S J
authors.initials: TS
authors.lastname: Elliott
authors.forename: R J
authors.initials: RJ
authors.lastname: Grimer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D019643:Arthroplasty, Replacement; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D003646:Debridement / Q000379:methods; D005260:Female; D006621:Hip Joint / Q000382:microbiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D007719:Knee Joint / Q000382:microbiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification
chemical_list: D000890:Anti-Infective Agents