title: Comparison of SSI rates in endoarthroplasty of hip and knee in a Cracow patient population and the importance of postdischarge surveillance.
abstract: BACKGROUND
  The aim of the study was to analyse the epidemiological and microbiological analysis of surgical site infections in patients that underwent knee or hip endoarthroplasty procedures.
  
  
  METHODS
  The epidemiological and microbiological surveillance was carried out by the local infection control team in cooperation with the Department of Bacteriology, at the Chair of Microbiology, Jagiellonian University Medical College in Cracow.
  
  
  RESULTS
  A total of 651 patients operated in the Department of Orthopedics, Trauma Surgery and Rehabilitation of Cracow Rehabilitation Center in Poland were analyzed. Twenty-three cases of SSI were detected. The cumulative incidence after hip prosthesis (HPRO) procedures was 2.3%, while for knee prosthesis (KPRO) it was 7.0. Standardized risk index, comparing the incidence in our study to German hospitals, shows a statistically significant, higher incidence in patients with knee replacement procedures in our study (p=0.004). Among etiological agents of SSIs, we demonstrated the dominating role of Gram-positive cocci to be 75% (30% methicillin resistant). This resistance was confirmed only in case of coagulasenegative staphylococci (no MRSA were cultured). Gramnegative rods were isolated with a frequency of 25%: 41.6% in SSI after hip endoarthroplasty and 15% after knee endoarthroplasty. Postdischarge surveillance encompassed 59% of operated patients.
  
  
  CONCLUSIONS
  The incidence of SSIs of hip prosthesis in our study was comparable to the incidence in the German KISS program, where surveillance is integrating a highly sensitive postdischarge detection. On the other hand, we observed a higher, statistically significant cumulative incidence in case of knee endoarthroplasty. Our microbiological data show effective control of methicillin-resistant Staphylococcus aureus and are also in agreement with the data found in literature referring to coagulasenegative multi-resistant staphylococci as an important problem in the orthopaedic surgery of the knee joint.
authors.affiliation: Department of Bacteriology, Jagiellonian University Medical College, Cracow Rehabilitation Centre, 18 Czysta Street, 31-121, Cracow, Poland. mbmach@cyf-kr.edu.pl
authors.forename: J
authors.initials: J
authors.lastname: Wójkowska-Mach
authors.forename: E
authors.initials: E
authors.lastname: Jaje
authors.forename: D
authors.initials: D
authors.lastname: Romaniszyn
authors.forename: M
authors.initials: M
authors.lastname: Kasparek
authors.forename: B
authors.initials: B
authors.lastname: Frańczuk
authors.forename: M
authors.initials: M
authors.lastname: Bulanda
authors.forename: P B
authors.initials: PB
authors.lastname: Heczko
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011044:Poland / Q000453:epidemiology; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology