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Multicenter Study
. 2022 Oct;28(10):1359-1366.
doi: 10.1016/j.cmi.2022.05.010. Epub 2022 May 18.

Preoperative and perioperative risk factors, and risk score development for prosthetic joint infection due to Staphylococcus aureus: a multinational matched case-control study

Reinaldo Espindola  1 , Venanzio Vella  2 , Natividad Benito  3 , Isabel Mur  3 , Sara Tedeschi  4 , Nicolò Rossi  4 , Johannes G E Hendriks  5 , Luisa Sorlí  6 , Oscar Murillo  7 , Mathew Scarborough  8 , Claire Scarborough  8 , Jan Kluytmans  9 , Mateo Carlo Ferrari  10 , Mathias W Pletz  11 , Iain Mcnamara  12 , Rosa Escudero-Sanchez  13 , Cedric Arvieux  14 , Cecile Batailler  15 , Frédéric-Antoine Dauchy  16 , Wai-Yan Liu  17 , Jaime Lora-Tamayo  18 , Julia Praena  19 , Andrew Ustianowski  20 , Elisa Cinconze  2 , Michele Pellegrini  2 , Fabio Bagnoli  2 , Jesús Rodríguez-Baño  21 , Maria Dolores Del Toro  22 ; ARTHR-IS group
Collaborators, Affiliations
Multicenter Study

Preoperative and perioperative risk factors, and risk score development for prosthetic joint infection due to Staphylococcus aureus: a multinational matched case-control study

Reinaldo Espindola et al. Clin Microbiol Infect. 2022 Oct.

Abstract

Objectives: We aim to identify the preoperative and perioperative risk factors associated with post-surgical Staphylococcus aureus prosthetic joint infections (PJI) and to develop and validate risk-scoring systems, to allow a better identification of high-risk patients for more efficient targeted interventions.

Methods: We performed a multicenter matched case-control study of patients who underwent a primary hip and knee arthroplasty from 2014 to 2016. Two multivariable models by logistic regression were performed, one for the preoperative and one for perioperative variables; predictive scores also were developed and validated in an external cohort.

Results: In total, 130 cases and 386 controls were included. The variables independently associated with S. aureus-PJI in the preoperative period were (adjusted OR; 95% CI): body mass index >30 kg/m2 (3.0; 1.9 to 4.8), resident in a long-term care facility (2.8; 1.05 to 7.5), fracture as reason for arthroplasty (2.7; 1.4 to 5.03), skin disorders (2.5; 0.9 to 7.04), previous surgery in the index joint (2.4; 1.3 to 4.4), male sex (1.9; 1.2 to 2.9) and American Society of Anesthesiologists index score 3 to 4 (1.8; 1.2 to 2.9). The area under the receiver operating characteristic curve was 0.73 (95% CI 0.68 to 0.78). In perioperative model, the risk factors were the previous ones plus surgical antibiotic prophylaxis administered out of the first 60 minutes before incision (5.9; 2.1 to 16.2), wound drainage for >72 hours after arthroplasty (4.5; 1.9 to 19.4) and use of metal bearing material versus ceramic (1.9; 1.1 to 3.3). The area under the receiver operating characteristic curve was 0.78 (95% CI 0.72 to 0.83). The predictive scores developed were validated in the external cohort.

Discussion: Predictive scores for S. aureus-PJI were developed and validated; this information would be useful for implementation of specific preventive measures.

Keywords: Arthroplasty; Case-control study; Multinational study; Prosthetic joint infection; Risk factors; Staphylococcus aureus.

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