Versions
- 2024-08-02 (2)
- 2024-08-02 (1)
Keywords
Knee and Hip prosthesis
antimicrobial prophylaxis
Abstract
Introduction
Surgical site infections (SSIs) are one of the most frequently encountered complications associated with increased length of hospital stay, costs, and hospital mortality. There is no national system for the comprehensive monitoring of the incidence of SSIs.
Methods
All patients undergoing orthopedic prosthetic surgery from April 1 to June 30, 2023, were enrolled. Clinical evaluation of the surgical site was conducted at 30 days, and a telephone follow-up at 90 days was performed using a specially designed questionnaire.
Results
A total of 59 patients were included. Surgery was performed on the knee in 71.19% and on the hip in 28.81%. The mean BMI observed was 28.25±2.97, and the mean ASA score was 2.67±0.58. Among comorbidities, 6 patients had diabetes mellitus. The incidence of SSIs was 5,08%, two infections occurred in knee prosthesis surgery and one in hip surgery. The data were analysed and diabetes was found as the main risk factor for the development of infection.
Conclusions
Although based on a small number of patients, the results are encouraging, especially considering that the patients had an average ASA score of more than 2 and a high BMI. However, to further reduce the risk of infection, improved hygiene measures have been implemented in the operating room and antibiotic prophylaxis protocol has been updated to take into account the potential for MRSA colonization.
References
Bandini L, D’Ancona F, Creti R, Ricchizzi E, Moro M.L, Gagliotti C, Vecchi E, Fabbri E, Cavazzuti L, Tedeschi S. Protocollo Sorveglianza Nazionale delle Infezioni del sito chirurgico (SNICh2) e indicatori di prevenzione negli Ospedali. (versione 1.0 - 12 ottobre 2022). Documento tecnico 0050406-15/12/2022-DGPRE-DGPRE-P
Romanini E, Tucci G, Zanoli G, Ascione T, Balato G, Baldini A, Borre S, Capanna R, Da Rin De Lorenzo F, Drago L, Falez F, Fantoni M, Galluccio P, Maccauro G, Macri E, Marsella L.T, Meani E, Molendini L.O, Momoli A, Mongardi M, Mugnaini M, Nocco L, Pellegrini A.V, Piccioli A, Riccio G, Romano C, Salomone C, Sandrone C, Schiavone Panni A, Sciortino R, Sessa G, Tarantino U, Tartaglia R, Venditti M, Zagra L, Pavan L. Linee Guida SIOT: Prevenzione delle infezioni in chirurgia ortopedica - SISTEMA NAZIONALE LINEE GUIDA DELL’ISTITUTO SUPERIORE DI SANITÀ- Società Italiana di Ortopedia e Traumatologia. 21 maggio 2021. https://siot.it/wp-content/uploads/2021/06/LG-366-SIOT-Prevenzione-delle-infezioni-in-chirurgia-ortopedica.pdf Accesso al 06/12/2023
Lazzarini L, de Lalla F. Treatment and prevention of prosthetic joint infections. Trends Med 2003; 3(2):75-82. Pharma Project Group srl
AMCLI ETS. Percorso Diagnostico LE INFEZIONI DI PROTESI ARTICOLARI E MEZZI DI OSTEOSINTESI. - Rif. 2023-14, rev. 2023. https://www.amcli.it/wp-content/uploads/2023/05/14_PD-protesi_def16mag2023-tabelle-def.pdf Accesso al 06/12/2023
[Borchardt RA, Tzizik D. Update on surgical site infections: The new CDC guidelines. JAAPA. 2018 Apr;31(4):52-54. doi: 10.1097/01.JAA.0000531052.82007.42. PMID: 30973535].
Marchi M, Pan A, Gagliotti C, Morsillo F, Parenti M, Resi D, Moro ML; Sorveglianza Nazionale Infezioni in Chirurgia (SNICh) Study Group. The Italian national surgical site infection surveillance programme and its positive impact, 2009 to 2011. Euro Surveill. 2014 May 29;19(21):20815. doi: 10.2807/1560-7917.es2014.19.21.20815. PMID: 24906378.
Hughes JM. Study on the efficacy of nosocomial infection control (SENIC Project): results and implications for the future. Chemotherapy. 1988;34(6):553-61. doi: 10.1159/000238624. PMID: 3243099.
Abbas M, Tartari E, Allegranzi B, Pittet D, Harbarth S. The Effect of Participating in a Surgical Site Infection (SSI) Surveillance Network on the Time Trend of SSI Rates: A Systematic Review. Infect Control Hosp Epidemiol. 2017 Nov;38(11):1364-1366. doi: 10.1017/ice.2017.186. Epub 2017 Aug 24. PMID: 2883649.
Lamagni T. Epidemiology and burden of prosthetic joint infections. J Antimicrob Chemother. 2014 Sep;69 Suppl 1:i5-10. doi: 10.1093/jac/dku247. PMID: 25135091.
Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am. 2005 Aug;87(8):1746-51. doi: 10.2106/JBJS.D.02937. PMID: 16085614.
Darouiche RO, Wall MJ Jr, Itani KM, Otterson MF, Webb AL, Carrick MM, Miller HJ, Awad SS, Crosby CT, Mosier MC, Alsharif A, Berger DH. Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. N Engl J Med. 2010 Jan 7;362(1):18-26. doi: 10.1056/NEJMoa0810988. PMID: 20054046.