1202 infection control & hospital epidemiology october 2015, vol. 36, no. 10 Table 3. Continued Variable
Undernutrition No Yes
Neurologic diseases No Yes
Rheumatologic diseases No Yes
Organ graft No Yes
PVD No Yes
n
31,745 933
32,438 240
32,336 342
32,635 43
32,007 671
Univariate analysis Incidence PJI (%)
1.75 5.36
1.84 2.92
1.85 2.34
1.85 2.33
1.84 2.38
P NA
<.001 NA
.36
NA .95
NA .92
.76 Hazard ratio 1
1.59 –
– –
– –
NOTE. HIV, human immunodeficiency virus; PJI, prosthetic joint infection after hip or knee arthroplasty; PVD, peripheral vascular disorders. aN=32,582.
was 284 days (95% CI, 281–286 days) and the median (range) time was 91 (0–1,631) days. If PJI occurred out of the arthroplasty stay (525 patients), the median (range) time was 119 (10–1,631) days, with a mean of 312 days (95% CI, 281–345 days) (Figures 3 and 4). The mean length of stay for PJI occurring during the repla-
cement stay was 28.2 days (95% CI, 22.9–33.5 days), with a median (range) of 23 (1–149) days, significantly longer than arthroplasty hospital stay without complication (mean, 10.3 days [95% CI, 10.2–10.4 days], median [range], 9 [1–149] days). The distribution of the hospitalization for PJI management
was mostly in the public sector (60%) compared with the arthroplasty stay (67% in private hospitals). Among the public sector, 58% of PJI patientswere treated in the regional university
hospital.Most PJI were surgical stays (75%), including a surgical procedure during the hospitalization; 7.5% of the PJI hospital stays were classified as complicated. The surgical procedures mainly performed in PJI stays were aspiration or biopsies (20%), partial or complete removal of the artificial joint (24%), and surgical cleaning of the prosthetic joint (34%). The most fre- quent surgical procedure associations performed were, decreas- ingly and whatever the location, (1) evacuation of pus and cleaning up the prosthetic joint; (2) complete exchange of joint replacement performed as a single operation, during which the infected prosthesis is removed, the bone is cleaned, and a new prosthesis is implanted; and (3) complete removal of the joint replacement, cleaning of the bone, and sometimes implantation of a temporary cement spacer, before new replacement.
Microbiology
The infectious agent was coded for 502 (61%) of the 828 PJI stays: Staphylococcus sp.were found in 46%, inwhich a resistance
was coded in 26%; there were 21 coded as methicillin-resistant S. aureus. One hundred and twenty patients among the 347 patients who had at least one codedmicroorganismhad a coded resistance, leading to a global resistance at 14%; Candida was codedin12hospitaldischarges(6patients). Among the 604 PJI patients, 347 (57%) had at least 1 coded microorganism, with 24% of these coded as drug resistant agents (17 patients with methicillin-resistant S. aureus and 66 with a multiresistant bacteria coded).
PJI Occurrence and Comorbidities
Associations between risk factors and PJI are described in Table 3. In univariate analysis, factors associated with PJI were aged at least 75 years, male sex, having replacement after 2008, and comorbidities such as diabetes, ulcer sore, cardiac device, urologic inflammatory diseases, liver diseases and alcohol abuse, chronic renal failure, undernutrition, and obesity. In multivariate analysis, factors associated with PJI remained age at least 75 years, male sex, having replacement after 2008, liver diseases and alcohol abuse, ulcer sore, urologic inflammatory diseases, chronic renal failure, undernutrition, and obesity. No significant association was found between PJI and diabetes, location of device, having hypertension or a cardiologic device, or cancer.
Long-Term Mortality
The overall inpatient mortality in arthroplasty patients was 5.4%; the part of inpatient mortality due to infection of the prosthesis was 1.9%. The inpatient case fatality in PJI patients was 11.4% in the overall period of surveillance. Mortality ratewas higher in patients with hip replacement or hip surgical
Multivariate analysisa (95% CI)
Reference 1.16 2.20 P
NA .01
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