Abstract
Introduction Historically, a majority of prosthetic joint infections (PJIs) grew Gram-positive bacteria. While previous studies stratified PJI risk with specific organisms by patient comorbidities, we compared infection rates and microbiologic characteristics of PJIs by hospital setting: a dedicated orthopaedic hospital versus a general hospital serving multiple surgical specialties. Methods A retrospective review of prospectively collected data on 11,842 consecutive primary hip and knee arthroplasty patients was performed. Arthroplasty cases performed between April 2006 and August 2008 at the general university hospital serving multiple surgical specialties were compared to cases at a single orthopaedic specialty hospital from September 2008 to August 2016. Results The general university hospital PJI incidence rate was 1.43%, with 5.3% of infections from Gram-negative species. In comparison, at the dedicated orthopaedic hospital, the overall PJI incidence rate was substantially reduced to 0.75% over the 8-year timeframe. Comparing the final two years of practice at the general university facility to the most recent two years at the dedicated orthopaedics hospital, the PJI incidence was significantly reduced (1.43% vs 0.61%). Though the overall number of infections was reduced, there was a significantly higher proportion of Gram-negative infections over the 8-year timeframe at 25.3%. Conclusion In transitioning from a multispecialty university hospital to a dedicated orthopaedic hospital, the PJI incidence has been significantly reduced despite a greater Gram-negative proportion (25.3% versus 5.3%). These results suggest a change in the microbiologic profile of PJI when transitioning to a dedicated orthopaedic facility and that greater Gram-negative antibiotic coverage could be considered.
Highlights
A majority of prosthetic joint infections (PJIs) grew Gram-positive bacteria
At the dedicated orthopaedics specialty hospital, the overall PJI incidence rate was substantially reduced to 0.75% (p=.0224) (Table 1)
When comparing the final two years of practice at the general university facility to the most recent two years at the dedicated orthopaedics specialty hospital, the PJI incidence was significantly reduced from the 1.43% incidence at the general university hospital to 0.61% infection rate at the dedicated orthopaedics specialty hospital (p=.0087) (Table 2), with a decrease in the length of surgery for infected cases occurring at the dedicated orthopaedics specialty hospital compared to the general university hospital (Table 3)
Summary
A majority of prosthetic joint infections (PJIs) grew Gram-positive bacteria. In transitioning from a multispecialty university hospital to a dedicated orthopaedic hospital, the PJI incidence has been significantly reduced despite a greater Gram-negative proportion (25.3% versus 5.3%). These results suggest a change in the microbiologic profile of PJI when transitioning to a dedicated orthopaedic facility and that greater Gram-negative antibiotic coverage could be considered. The purpose of this study was to identify and compare the incidence of prosthetic joint infection (PJI) and characterize the microbiologic profile of these infections that occurred between two hospital settings: a general university hospital and a dedicated orthopaedic specialty hospital
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