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Periprosthetic Infection following Primary Hip and Knee Arthroplasty: The Impact of Limiting the Postoperative Surveillance Period

Published online by Cambridge University Press:  11 November 2016

Virginia R. Roth ,
Robyn Mitchell ,
Julie Vachon ,
Stéphanie Alexandre ,
Kanchana Amaratunga ,
Stephanie Smith ,
Mary Vearncombe ,
Ian Davis ,
Dominik Mertz  and
Elizabeth Henderson
...Show all authors
Virginia R. Roth
Affiliation:
Department of Medicine and School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa and Ottawa Hospital Research Institute. Ottawa, Ontario, Canada
Robyn Mitchell
Affiliation:
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
Julie Vachon
Affiliation:
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
Stéphanie Alexandre
Affiliation:
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
Kanchana Amaratunga
Affiliation:
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
Stephanie Smith
Affiliation:
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Mary Vearncombe
Affiliation:
Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario, Canada
Ian Davis
Affiliation:
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
Dominik Mertz
Affiliation:
Departments of Medicine, Clinical Epidemiology and Biostatistics, Pathology and Molecular Medicine, and Michael G. DeGroote Institute for Infectious Diseases Research, McMaster University, Hamilton, Ontario, Canada
Elizabeth Henderson
Affiliation:
Alberta Health Services and Department of Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
Michael John
Affiliation:
Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
Lynn Johnston
Affiliation:
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
Camille Lemieux
Affiliation:
University Health Network, Toronto, Ontario, Canada
Linda Pelude
Affiliation:
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
Denise Gravel
Affiliation:
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Abstract

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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 2 , February 2017 , pp. 147 - 153
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

a

Members of the Canadian Nosocomial Infection Surveillance Program: Alice Wong, Royal University Hospital, Saskatoon, SK; Allison McGeer, Mount Sinai Hospital, Toronto, ON; Andrew Simor, Sunnybrook Health Sciences Centre, Toronto, ON; Bonita Lee, Stollery Children’s Hospital, Edmonton, AB; Camille Lemieux, University Health Network, Toronto, ON; Caroline Quach, Montreal Children’s Hospital, Montreal, QC; Charles Frenette, McGill University Health Centre, Montreal, QC; Chelsey Ellis,The Moncton Hospital, Moncton, NB; Deanna Hembroff, University Hospital of Northern BC, Prince George, BC; Dominik Mertz, Hamilton Health Sciences Corporation, Hamilton, ON; Dorothy Moore, Montreal Children’s Hospital, Montreal, QC; Elizabeth Bryce, Vancouver Coastal Health Authority, Vancouver, BC; Elizabeth Henderson, Alberta Health Services, Calgary, AB; Geoffrey Taylor, University of Alberta Hospital, Edmonton, AB; Gerald Evans, Kingston General Hospital, Kingston, ON; Gregory German, Queen Elizabeth Hospital, Charlottetown, PEI; Ian Davis, QEII Health Sciences Centre, Halifax, NS; Janice de Heer, Interior Health Authority, Kelowna, BC; Jessica Minion, Regina Qu’Appelle Health Region, Regina, SK; Joanne Embree, Health Sciences Centre, Winnipeg, MB; Joanne Langley, IWK.Health Centre, Halifax, NS; Jocelyn Srigley, Children and Women’s Hospital of British Columbia, Vancouver, BC; John Conly, Foothills Medical Centre, Calgary, AB; John Embil, Health Sciences Centre, Winnipeg, MB; Joseph Vayalumkal, Alberta Children’s Hospital, Calgary, AB; Karl Weiss, Maisonneuve-Rosemont Hospital, Montreal, QC; Kathryn Suh, The Ottawa Hospital, Ottawa, ON; Kevin Katz, North York General Hospital, Toronto, ON; Lynn Johnston, Queen Elizabeth II Health Sciences Centre, Halifax, NS; Marie-Astrid Lefebvre, Montreal Children’s Hospital, Montreal, QC; Mark Loeb, Hamilton Health Sciences Corporation, Hamilton, ON; Mary Vearncombe, Sunnybrook Health Sciences Centre, Toronto, ON; Michael John, London Health Sciences Centre, London, ON; Natalie Bridger, Eastern Health-HSC, St. John’s, NL; Nathalie Turgeon, CHUQ-Hôtel-Dieu, Québec, QC; Nisha Thampi, Children’s Hospital of Eastern Ontario, Ottawa, ON; Pamela Kibsey, Royal Jubilee Hospital, Victoria, BC; Paula Stagg, Western Memorial Hospital, Corner Brook, NL; Stephanie Smith, University of Alberta Hospital, Edmonton, AB; Susan Richardson, Hospital for Sick Children, Toronto, ON; Suzanne Pelletier, Health Sciences North, Sudbury, ON; Virginia Roth, The Ottawa Hospital, Ottawa, ON; Yves Longtin, SMBD-Jewish General Hospital, Montreal, QC.

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