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Risk Factors for Surgical-Site Infection Following Primary Total Knee Arthroplasty

Published online by Cambridge University Press:  02 January 2015

Brian Minnema ,
Mary Vearncombe ,
Anne Augustin ,
Jeffrey Gollish  and
Andrew E. Simor
Brian Minnema
Affiliation:
Department of Microbiology and Dr. Gollish is from the Department of Surgery, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
Mary Vearncombe
Affiliation:
Department of Microbiology and Dr. Gollish is from the Department of Surgery, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Anne Augustin
Affiliation:
Department of Microbiology and Dr. Gollish is from the Department of Surgery, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
Jeffrey Gollish
Affiliation:
University of Toronto, Toronto, Ontario, Canada
Andrew E. Simor*
Affiliation:
Department of Microbiology and Dr. Gollish is from the Department of Surgery, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
*
Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, B121-2075 Bayview Avenue, Toronto, Ontario, CanadaM4N 3M5
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Abstract

Objective:

To identify risk factors associated with the development of surgical-site infection (SSI) following total knee arthroplasty (TKA).

Design:

A case-control study.

Setting:

A 1,100-bed, university-affiliated, tertiary-care teaching hospital.

Methods:

Case-patients with SSI occurring up to 1 year following primary TKA performed between January 1999 and December 2001 were identified prospectively by infection control practitioners using National Nosocomial Infections Surveillance (NNIS) System methods. Three control-patients were selected for each case-patient, matched by date of surgery. Stepwise logistic regression analysis was used to determine the relation of potential risk factors to the development of infection.

Results:

Twenty-two patients with infections (6 superficial and 16 deep) were identified. Infection rates per year were 0.95%, 1.07%, and 1.19% in 1999, 2000, and 2001, respectively. Logistic regression analysis identified two variables independently associated with the development of infection: the use of closed suction drainage (odds ratio [OR], 7.0; 95% confidence interval [CI95], 2.1-25.0; P = .0015) and increased international normalized ratio (INR) (OR, 2.4; CI95, 1.1-5.7; P = .035). Factors not statistically associated with the development of infection included age, NNIS System risk index score, presence of various comorbidities, surgeon, duration of procedure or tourniquet time, type of bone cement or prosthesis used, or receipt of blood product transfusions.

Conclusions:

The use of closed suction drainage and a high postoperative INR were associated with the development of SSI following TKA. Avoiding the use of surgical drains and careful monitoring of anticoagulant prophylaxis in patients undergoing TKA should reduce the risk of infection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 6 , June 2004 , pp. 477 - 480
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1.Harris, WH, Sledge, CB. Total hip and total knee replacement. N Engl J Med 1990;323:801–807.Google Scholar
2.Grogan, TJ, Dorey, F, Rollins, J, Amstutz, HC. Deep sepsis following total knee arthroplasty: ten year experience at the University of California at Los Angeles Medical Center. J Bone Joint Surg Am 1986;68:226–234.Google Scholar
3.Wymenga, AB, van Horn, JR, Theeuwes, A, Muytjens, HL, Slooff, TJJH. Perioperative factors associated with septic arthritis after arthroplasty: prospective multicenter study of 362 knee and 2,651 hip operations. Acta Orthop Scand 1992;63:665–671.Google Scholar
4.Gaine, WJ, Ramamohan, NA, Hussein, NA, Hullin, MG, McCreath, SW. Wound infection in hip and knee arthroplasty. J Bone Joint Surg Br 2000;82:561–565.CrossRefGoogle ScholarPubMed
5.Peersman, G, Laskin, R, Davis, J, Peterson, M. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop 2001;392:15–23.Google Scholar
6.Lentino, JR. Prosthetic joint infections: bane of orthopedists, challenge for infectious disease specialists. Clin Infect Dis 2003;36:1157–1161.Google Scholar
7.Morrey, BF, Westholm, F, Schoifet, SS, Rand, JA, Bryan, RS. Long-term results of various treatment options for infected total knee arthroplasty. Clin Orthop 1989;248:120–126.Google Scholar
8.Bengston, S, Knutson, K. The infected knee arthroplasty: a 6-year follow-up of 357 cases. Acta Orthop Scand 1991;62:301–311.Google Scholar
9.Kramhoft, M, Bodtker, S, Carlsen, A. Outcome of infected total knee arthroplasty. J Arthroplasty 1994;9:617–621.Google Scholar
10.Poss, R, Thornhill, TS, Ewald, FC, Thomas, WH, Batte, NJ, Sledge, CB. Factors influencing the incidence and outcome of infection following total joint arthroplasty. Clin Orthop 1984;182:117–126.Google Scholar
11.Knutson, K, Lindstrand, A, Lidgren, L. Survival of knee arthroplasties: a nationwide multicentre investigation of 8000 cases. J Bone Joint Surg Am Br 1986;68:795–803.Google Scholar
12.Wilson, MG, Kelley, K, Thornhill, TS. Infection as a complication of total knee-replacement arthroplasty: risk factors and treatment in sixty-seven cases. J Bone Joint Surg Am 1990;72:878–883.Google Scholar
13.Winiarsky, R, Barth, P, Lotke, P. Total knee arthroplasty in morbidly obese patients. J Bone Joint Surg Am 1998;12:1770–1774.Google Scholar
14.Centers for Diseases Control and Prevention, Healthcare Infection Control Practices Advisory Committee. Guideline for the prevention of surgical site infections, 1999. Am J Infect Control 1999;27:97–119.Google Scholar
15.Lazzarini, L, Pellizzer, G, Stecca, C, Viola, R, De Lalla, F. Postoperative infections following total knee replacement: an epidemiological study. J Chemother 2001;13:182–187.Google Scholar
16.Berbari, EF, Hanssen, AD, Duffy, MC, et al.Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis 1998;27:1247–1254.Google Scholar
17.Gordon, SM, Culver, DH, Simmons, BP, Jarvis, WR. Risk factors for wound infections after total knee arthroplasty. Am J Epidemiol 1990;131:905–916.Google Scholar
18.Waugh, TR, Stinchfield, FE. Suction drainage of orthopaedic wounds. Am J Orthop 1961;43A:939–946.Google Scholar
19.Reilly, TJ, Gradisar, IA Jr, Pakan, W, Reilly, M. The use of postoperative suction drainage in total knee arthroplasty. Clin Orthop 1986;208:238–242.Google Scholar
20.Ovadia, D, Luger, E, Bickels, J, Menachem, A, Dekel, S. Efficacy of closed wound drainage after total joint arthroplasty: a prospective randomized study. J Arthroplasty 1997;12:317–321.CrossRefGoogle ScholarPubMed
21.Kim, Y-H, Cho, S-H, Kim, R-S. Drainage versus nondrainage in simultaneous bilateral total knee arthroplasties. Clin Orthop 1998;347:188–193.Google Scholar
22.Ashraf, T, Darmanis, S, Krikler, SJ. Effectiveness of suction drainage after primary or revision total hip and total knee arthroplasty. Orthopedics 2001;24:1158–1160.CrossRefGoogle ScholarPubMed
23.Esler, CNA, Blakeway, C, Fiddian, NJ. The use of a closed-suction drain in total knee arthroplasty: a prospective randomised study. J Bone Joint Surg Br 2003;85:215–217.Google Scholar
24.Willett, KM, Simmons, CD, Bentley, G. The effect of deep suction drains following total hip arthroplasty. J Bone Joint Surg Br 1988;70:607–609.Google Scholar
25.Drinkwater, CJ, Neil, MJ. Optimal timing of wound drain removal following total joint arthroplasty. J Arthroplasty 1995;10:185–189.Google Scholar
26.Nora, PF, Vanecko, RM, Bransfield, JJ. Prophylactic abdominal drains. Arch Surg 1972;105:173–177.CrossRefGoogle ScholarPubMed
27.Simchen, E, Rozin, R, Wax, Y. The Israeli study of surgical infection of drains and the risk of wound infection in operations for hernia. Surg Gynecol Obstet 1990;170:331–334.Google ScholarPubMed
28.Cobb, JP. Why use drains? J Bone Joint Surg Br 1990;72:993–995.Google Scholar
29.Geerts, WH, Heit, JA, Clagett, GP, et al.Prevention of venous thromboembolism. Chest 2001;119(suppl 1):132S–175S.Google Scholar
30.Douketis, JD, Eikelboom, JW, Quinlan, DJ, Willan, AR, Crowther, MA. Short-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of prospective studies investigating symptomatic outcomes. Arch Intern Med 2002;162:1465–1471.Google Scholar
31.Krizek, TJ, Davis, JH. The role of the red cell in subcutaneous infection. J Trauma 1965;5:85–89.Google Scholar
32.Saleh, K, Olson, M, Resig, S, et al.Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program. J Orthopaedic Research 2002;20:506–515.Google Scholar