Increased infection risk after hip hemiarthroplasty in institutionalized patients with proximal femur fracture |
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| Affiliation: | 1. Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain;2. Infectious Diseases Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain;3. Osteoarticular Rehabilitation Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Spain;4. Microbiology Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain;1. Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia;2. Department of Orthopaedic Surgery, Epworth Healthcare, Richmond, Victoria 3121, Australia;3. Centre for Limb Reconstruction, The Epworth Centre, Richmond, Victoria 3121, Australia;4. Department of Surgery, Southern Clinical School, Monash University, Clayton, Victoria 3168, Australia;1. Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, United States;2. Department of Hand Surgery, Nagoya University Graduate School of Medicine, Japan;1. NYU Hospital for Joint Diseases, United States;2. Jamaica Hospital Medical Center, United States |
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| Abstract: | In patients undergoing hip hemiarthroplasty (HHA) secondary to proximal femur fracture, acute periprosthetic joint infection (PJI) is one of the most important complications. We have detected an increased risk of PJI in chronic institutionalized patients (CIPs), and a higher number of early postoperative infections are caused by Gram-negative bacteria (GNB), not covered by the current prophylaxis (cefazolin in noninstitutionalized patients (NIPs) and cotrimoxazole in CIPs). We sought to compare infection characteristics between NIPs and CIPs, analyzing predisposing factors, causative pathogens, and antibiotic prophylaxis-related microbiological characteristics. We performed a retrospective review of our prospective institutional database to identify all patients consecutively admitted for HHA to treat proximal femur fracture at our centre between 2011 and 2013. PJI was diagnosed in 21 of 381 (5.51%) patients, with 10 of 105 (9.52%) in the CIP group and 11 of 276 (3.99%) in the NIP group, and statistical significance was achieved. GNB accounted for PJI in 14 (66.67%) patients. We detected a single case of methicillin-resistant Staphylococcus aureus (MRSA) infection in the NIP group.We confirm a higher risk of acute PJI among institutionalized patients, commonly caused by Gram-negative microorganisms, which are not covered by the current prophylaxis. New prophylactic strategies should be investigated in order to reduce this problem. |
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| Keywords: | Hip hemiarthroplasty Acute periprosthetic joint infection Antibiotic prophylaxis |
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