Increased risk of prosthetic joint infection associated with esophago-gastro-duodenoscopy with biopsy.
BACKGROUND
There are no prospective data regarding the risk of prosthetic joint infection following routine gastrointestinal endoscopic procedures. We wanted to determine the risk of prosthetic hip or knee infection following gastrointestinal endoscopic procedures in patients with joint arthroplasty.


METHODS
We conducted a prospective, single-center, case-control study at a single, tertiary-care referral center. Cases were defined as adult patients hospitalized for prosthetic joint infection of the hip or knee between December 1, 2001 and May 31, 2006. Controls were adult patients with hip or knee arthroplasties but without a diagnosis of joint infection, hospitalized during the same time period at the same orthopedic hospital. The main outcome measure was the odds ratio (OR) of prosthetic joint infection after gastrointestinal endoscopic procedures performed within 2 years before admission.


RESULTS
339 cases and 339 controls were included in the study. Of these, 70 cases (21%) cases and 82 controls (24%) had undergone a gastrointestinal endoscopic procedure in the preceding 2 years. Among gastrointestinal procedures that were assessed, esophago-gastro-duodenoscopy (EGD) with biopsy was associated with an increased risk of prosthetic joint infection (OR = 3, 95% CI: 1.1-7). In a multivariable analysis adjusting for sex, age, joint age, immunosuppression, BMI, presence of wound drain, prior arthroplasty, malignancy, ASA score, and prothrombin time, the OR for infection after EGD with biopsy was 4 (95% CI: 1.5-10).


CONCLUSIONS
EGD with biopsy was associated with an increased risk of prosthetic joint infection in patients with hip or knee arthroplasties. This association will need to be confirmed in other epidemiological studies and adequately powered prospective clinical trials prior to recommending antibiotic prophylaxis in these patients.
Division of Gastroenterology, Mayo Clinic, Rochester, MN, USA.
Nayantara
N
Coelho-Prabhu
Amy S
AS
Oxentenko
Douglas R
DR
Osmon
Todd H
TH
Baron
Arlen D
AD
Hanssen
Walter R
WR
Wilson
James M
JM
Steckelberg
Larry M
LM
Baddour
William S
WS
Harmsen
Jay
J
Mandrekar
Elie F
EF
Berbari
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D016022:Case-Control Studies; D004384:Duodenoscopy / Q000009:adverse effects*; D004945:Esophagoscopy / Q000009:adverse effects*; D005260:Female; D005773:Gastroscopy / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000209:etiology*; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000209:etiology; D013997:Time Factors