Periprosthetic Infection following Primary Hip and Knee Arthroplasty: The Impact of Limiting the Postoperative Surveillance Period.
BACKGROUND Hip and knee arthroplasty infections are associated with considerable healthcare costs. The merits of reducing the postoperative surveillance period from 1 year to 90 days have been debated. OBJECTIVES To report the first pan-Canadian hip and knee periprosthetic joint infection (PJI) rates and to describe the implications of a shorter (90-day) postoperative surveillance period. METHODS Prospective surveillance for infection following hip and knee arthroplasty was conducted by hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) using standard surveillance definitions. RESULTS Overall hip and knee PJI rates were 1.64 and 1.52 per 100 procedures, respectively. Deep incisional and organ-space hip and knee PJI rates were 0.96 and 0.71, respectively. In total, 93% of hip PJIs and 92% of knee PJIs were identified within 90 days, with a median time to detection of 21 days. However, 11%-16% of deep incisional and organ-space infections were not detected within 90 days. This rate was reduced to 3%-4% at 180 days post procedure. Anaerobic and polymicrobial infections had the shortest median time from procedure to detection (17 and 18 days, respectively) compared with infections due to other microorganisms, including Staphylococcus aureus. CONCLUSIONS PJI rates were similar to those reported elsewhere, although differences in national surveillance systems limit direct comparisons. Our results suggest that a postoperative surveillance period of 90 days will detect the majority of PJIs; however, up to 16% of deep incisional and organ-space infections may be missed. Extending the surveillance period to 180 days could allow for a better estimate of disease burden. Infect Control Hosp Epidemiol 2017;38:147-153.
1Department of Medicine and School of Epidemiology,Public Health and Preventative Medicine,University of Ottawaand Ottawa Hospital Research Institute.Ottawa,Ontario,Canada.
Virginia R
VR
Roth
2Centre for Communicable Diseases and Infection Control,Public Health Agency of Canada,Ottawa,Ontario,Canada.
Robyn
R
Mitchell
2Centre for Communicable Diseases and Infection Control,Public Health Agency of Canada,Ottawa,Ontario,Canada.
Julie
J
Vachon
2Centre for Communicable Diseases and Infection Control,Public Health Agency of Canada,Ottawa,Ontario,Canada.
Stéphanie
S
Alexandre
2Centre for Communicable Diseases and Infection Control,Public Health Agency of Canada,Ottawa,Ontario,Canada.
Kanchana
K
Amaratunga
3Department of Medicine,University of Alberta,Edmonton,Alberta,Canada.
Stephanie
S
Smith
4Sunnybrook and Women's College Health Sciences Centre,Toronto,Ontario,Canada.
Mary
M
Vearncombe
5Department of Medicine,Dalhousie University,Halifax,Nova Scotia,Canada.
Ian
I
Davis
6Departments of Medicine,Clinical Epidemiology and Biostatistics,Pathology and Molecular Medicine,and Michael G. DeGroote Institute for Infectious Diseases Research,McMaster University,Hamilton,Ontario,Canada.
Dominik
D
Mertz
7Alberta Health Services and Department of Community Health Sciences,Cummings School of Medicine,University of Calgary,Calgary,Alberta,Canada.
Elizabeth
E
Henderson
8Department of Pathology and Laboratory Medicine,Schulich School of Medicine and Dentistry,Western University,London,Ontario,Canada.
Michael
M
John
5Department of Medicine,Dalhousie University,Halifax,Nova Scotia,Canada.
Lynn
L
Johnston
9University Health Network,Toronto,Ontario,Canada.
Camille
C
Lemieux
2Centre for Communicable Diseases and Infection Control,Public Health Agency of Canada,Ottawa,Ontario,Canada.
Linda
L
Pelude
2Centre for Communicable Diseases and Infection Control,Public Health Agency of Canada,Ottawa,Ontario,Canada.
Denise
D
Gravel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D002170:Canada / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013997:Time Factors