Risk factors for total joint arthroplasty infection in patients receiving tumor necrosis factor α-blockers: a case-control study.
BACKGROUND
The objective of this study was to assess natural microbial agents, history and risk factors for total joint arthroplasty (TJA) infections in patients receiving tumor necrosis factor (TNF)α-blockers, through the French RATIO registry and a case-control study.


METHODS
Cases were TJA infections during TNFα-blocker treatments. Each case was compared to two controls (with TJA and TNFα-blocker therapy, but without TJA infection) matched on age (±15 years), TJA localization, type of rheumatic disorder and disease duration (±15 years). Statistical analyses included univariate and multivariate analyses with conditional logistic regression.


RESULTS
In the 20 cases (18 rheumatoid arthritis), TJA infection concerned principally the knee (n = 12, 60%) and the hip (n = 5, 25%). Staphylococcus was the more frequent microorganism involved (n = 15, 75%). Four patients (20%) were hospitalized in an intensive care unit and two died from infection. Eight cases (40%) versus 5 controls (13%) had undergone primary TJA or TJA revision for the joint subsequently infected during the last year (P = 0.03). Of these procedures, 5 cases versus 1 control were performed without withdrawing TNFα-blockers (P = 0.08). In multivariate analysis, predictors of infection were primary TJA or TJA revision for the joint subsequently infected within the last year (odds ratio, OR = 88.3; 95%CI 1.1-7,071.6; P = 0.04) and increased daily steroid intake (OR = 5.0 per 5 mg/d increase; 1.1-21.6; P = 0.03). Case-control comparisons showed similar distribution between TNFα-blockers (P = 0.70).


CONCLUSIONS
In patients receiving TNFα-blockers, TJA infection is rare but potentially severe. Important risk factors are primary TJA or TJA revision within the last year, particularly when TNFα-blockers are not interrupted before surgery, and the daily steroid intake.
Gilson
Mélanie
M
Rheumatology B Department, Cochin Hospital, Paris 75014, France. melanie.gilson@gmail.com
Gossec
Laure
L
Mariette
Xavier
X
Gherissi
Dalenda
D
Guyot
Marie-Hélène
MH
Berthelot
Jean-Marie
JM
Wendling
Daniel
D
Michelet
Christian
C
Dellamonica
Pierre
P
Tubach
Florence
F
Dougados
Maxime
M
Salmon
Dominique
D
D000368:Aged; D019643:Arthroplasty, Replacement / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries / Q000706:statistics & numerical data; D012216:Rheumatic Diseases / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000401:mortality*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha