[Arthroplasty-related infection: incidence, risk factors, clinical features, and outcome].
BACKGROUND
There is little information about the overall incidence, risk factors, and clinical management of arthroplasty-related infection in Spain.


METHODS
The incidence of surgical site infection (SSI) in hip and knee arthroplasty from 2001 to 2005 was determined. Risk factors for SSI were investigated in 435 patients using multivariate logistic regression analysis. Clinical features and treatment were examined in a cohort of 58 consecutive patients with joint arthroplasty infection.


RESULTS
The percentages of SSI in hip and knee arthroplasty stratified according to the National Nosocomial Infection Surveillance (NNIS) index were 1.86% and 1.62% (NNIS=0), 3.72% and 2.02% (NNIS=1), and 7.20% and 6.71% (NNIS=2-3), respectively. The risk factors identified for developing SSI included secondary arthroplasty, duration of urinary catheterization, and hip arthroplasty. Fifty percent of patients with arthroplasty infection had type I (early) or III (hematogenous) infection. Gram-positive cocci were the most frequent causes. Initial therapy consisted in debridement with preservation of the prosthesis (10 patients) or removal of the prosthesis (40 patients); surgery was not performed in 8 patients. After one year of follow up, 39 patients (67%) were considered cured, 12 (21%) had a recurrence or were under chronic suppressive antimicrobial therapy, and 7 (12%) had died.


CONCLUSIONS
The incidence of SSI in our center is similar to that of other Spanish hospitals, but is higher than the notified incidence in the NNIS system. A modifiable risk factor (urinary catheterization) has been identified. Greater consensus for the management of these patients is desirable.
Rodríguez-Baño
Jesús
J
Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Sevilla, Spain. jrb@nacom.es
del Toro
María Dolores
MD
Lupión
Carmen
C
Suárez
Ana Isabel
AI
Silva
Luis
L
Nieto
Isabel
I
Muniain
Miguel Angel
MA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology; D003646:Debridement; D020878:Device Removal / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D014546:Urinary Catheterization / Q000009:adverse effects
D000900:Anti-Bacterial Agents