This document provides an overview of approaches for treating periprosthetic infection. It discusses the epidemiology and risk factors for infection, presentation and etiology of different types of infection, diagnosis methods including imaging, blood tests, and joint aspiration. Treatment options include surgical approaches like debridement with or without prosthesis retention, one-stage or two-stage replacement arthroplasty, resection arthroplasty, and nonsurgical suppressive antibiotic therapy. The gold standard treatment for infection beyond 4 weeks is two-stage replacement arthroplasty involving removal of the prosthesis, debridement, antibiotics, and delayed reimplantation.
A discussion on the risk factors, classification and clinical presentation of surgical site infection. Also elucidates the overview of management approach to SSI.
Surgical site Infection during Internship in medical college.pptxrautkrisna
Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital. SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wellbeing. SSI can double the length of time a patient stays in hospital and thereby increase the costs of health care. Additional costs attributable to SSI of between 814 and 6626 have been reported depending on the type of surgery and the severity of the infection. The main additional costs are related to re-operation, extra nursing care and interventions, and drug treatment costs. The indirect costs, due to loss of productivity, patient dissatisfaction and litigation, and reduced quality of life, have been studied less extensively.Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital. SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wllbeing
A discussion on the risk factors, classification and clinical presentation of surgical site infection. Also elucidates the overview of management approach to SSI.
Surgical site Infection during Internship in medical college.pptxrautkrisna
Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital. SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wellbeing. SSI can double the length of time a patient stays in hospital and thereby increase the costs of health care. Additional costs attributable to SSI of between 814 and 6626 have been reported depending on the type of surgery and the severity of the infection. The main additional costs are related to re-operation, extra nursing care and interventions, and drug treatment costs. The indirect costs, due to loss of productivity, patient dissatisfaction and litigation, and reduced quality of life, have been studied less extensively.Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital. SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wllbeing
According to the National Center for Health Statistics, approximately 46 million surgical procedures are performed annually in the United States, the majority of which are done in an outpatient setting.1
Infection is the most common complication of surgery.2
Surgical site infections (SSIs) occur in approximately 3% to 6% of
patients and prolong hospitalization by an average of 7 days at a direct annual cost of $5 to $10 billion.3,4
SSIs are the third (14%–16%) most frequent cause of nosocomial infections among hospitalized patients.3
Infection occurs within 30 days after the operative procedure if no implant is left in place or within 1 year if implant is in place and the infection appears to be related to the operative procedure
risk factors includes
Age
Obesity
Diabetes
Malnutrition
Prolonged preoperative stay
Infection at remote site
Systemic steroid use
Nicotine use
REDUCING INFECTION RISKS IN KNEE REPLACEMENT SURGERY BEST PRACTICES AND APPRO...Lovina Kapoor
Knee replacement surgery, also known as knee arthroplasty, is a highly successful procedure that offers relief to individuals suffering from chronic knee pain and disability. While the surgery is generally safe, one of the significant concerns in knee replacement procedures is the risk of infection. Infection after knee replacement surgery can lead to serious complications, prolonged recovery, and even the need for additional surgeries.
Abstract— Joint replacement operations which are applied to reduce the pain and increase the movement capacity are among the surgical procedures that are used mostly nowadays. Even though a dramatic recovery is seen in the life of the patient after total knee prosthesis, possible prosthesis infection increases cost and causes high morbidity. This study was conducted with the aim to determine rates of surgical site infection after performing primer total knee prothesis operation in our clinic. Furthermore, it has been intended to understand risk factors which may cause infection and then take precautions. This study was conducted from January 2008 to January 2013, 252 knees underwent primary total knee arthroplasty operations. Among these patients infection rates, relationship to risk factors and infection treatments were analysed. It was observed that iIn 252 knees, 10 (4%) superficial infections were found, debridement and antibiotics were applied to 3 knees out of 10 and only antibiotic treatment was applied to the rest 7 knees. Deep infection was detected in 4 knees (1,6%) out of 252. Acute deep infection in 1 knee and recovery was provided with debridement and intravenous antibiotics treatment. Late deep infection was not detected in any of patients. Delayed deep infection was detected in 3 (1,1%) of these knees though. Among all risk factors only increased body mass index showed increased superficial wound infection rate. It can be concluded that among the factors like rheumatoid arthritis, diabetes, age, gender, body mass index, just body mass index has an impact on superficial infection rate. Our infection rates were comparable to rates mentioned in universal literature for primary total knee replacement operations.
According to the National Center for Health Statistics, approximately 46 million surgical procedures are performed annually in the United States, the majority of which are done in an outpatient setting.1
Infection is the most common complication of surgery.2
Surgical site infections (SSIs) occur in approximately 3% to 6% of
patients and prolong hospitalization by an average of 7 days at a direct annual cost of $5 to $10 billion.3,4
SSIs are the third (14%–16%) most frequent cause of nosocomial infections among hospitalized patients.3
Infection occurs within 30 days after the operative procedure if no implant is left in place or within 1 year if implant is in place and the infection appears to be related to the operative procedure
risk factors includes
Age
Obesity
Diabetes
Malnutrition
Prolonged preoperative stay
Infection at remote site
Systemic steroid use
Nicotine use
REDUCING INFECTION RISKS IN KNEE REPLACEMENT SURGERY BEST PRACTICES AND APPRO...Lovina Kapoor
Knee replacement surgery, also known as knee arthroplasty, is a highly successful procedure that offers relief to individuals suffering from chronic knee pain and disability. While the surgery is generally safe, one of the significant concerns in knee replacement procedures is the risk of infection. Infection after knee replacement surgery can lead to serious complications, prolonged recovery, and even the need for additional surgeries.
Abstract— Joint replacement operations which are applied to reduce the pain and increase the movement capacity are among the surgical procedures that are used mostly nowadays. Even though a dramatic recovery is seen in the life of the patient after total knee prosthesis, possible prosthesis infection increases cost and causes high morbidity. This study was conducted with the aim to determine rates of surgical site infection after performing primer total knee prothesis operation in our clinic. Furthermore, it has been intended to understand risk factors which may cause infection and then take precautions. This study was conducted from January 2008 to January 2013, 252 knees underwent primary total knee arthroplasty operations. Among these patients infection rates, relationship to risk factors and infection treatments were analysed. It was observed that iIn 252 knees, 10 (4%) superficial infections were found, debridement and antibiotics were applied to 3 knees out of 10 and only antibiotic treatment was applied to the rest 7 knees. Deep infection was detected in 4 knees (1,6%) out of 252. Acute deep infection in 1 knee and recovery was provided with debridement and intravenous antibiotics treatment. Late deep infection was not detected in any of patients. Delayed deep infection was detected in 3 (1,1%) of these knees though. Among all risk factors only increased body mass index showed increased superficial wound infection rate. It can be concluded that among the factors like rheumatoid arthritis, diabetes, age, gender, body mass index, just body mass index has an impact on superficial infection rate. Our infection rates were comparable to rates mentioned in universal literature for primary total knee replacement operations.
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It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
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2. I. Epidemiology and Overview
• Prevalence
• The risk of periprosthetic infection following
primary knee arthroplasty (1% to 2%) is
slightly higher than that following hip
arthroplasty (0.3% to 1.3%).
• The risk of infection is higher after revision
procedures: 3% for hips and 6% for knees.
3. 1.Risk factors
1.Postoperative surgical site infection or hematoma
formation
2.Wound healing complications
3.Malignant disease
4.Prior joint arthroplasty
5.Prior surgery or infection of the joint or adjacent bone
6.Perioperative nonarticular infection
7.Rheumatoid arthritis
8.Psoriasis
9.Diabetes
4. • Prophylaxis
• —Administration of antibiotics within 60
minutes before surgery is the most effective
method for prevention of periprosthetic
infection.
5. II. Presentation and Etiology
Type of Infection Etiology Time of Onset Signs and Symptoms
Acute
postoperative
infection
Frequently caused by
Staphylococcus aureus, B-
hemolytic Stretptococcus, and
sometimes by gram-negative
bacteria
Symptoms appear
within days to weeks
Acute onset of joint pain and
swelling together with
erythema, warmth, tenderness,
and possible wound discharge
Sinus tract extending to the joint
is a definitive sign of infection
Late chronic
infection
Frequently caused by less-
virulent organisms: coagulase-
negative Staphylococcus and
Propionibacterium acnes
Occurs several months
to 2 years after
prosthesis implantation
Subtle signs and symptoms, if
any
Chronic pain and implant
loosening are common
Difficult to differentiate from
mechanical aseptic loosening,
but pain associated with chronic
infection worsens with time and
is accompanied by deterioration
in function.
Hematogenous
seeding
Inciting events: skin infection,
dental extraction, respiratory
tract infection, urinary tract
infection
Within days after
inciting event
Sudden onset of pain
6. III. Diagnosis
A-History and physical examination
– A detailed history and physical examination can
diagnose periprosthetic infection with reasonable
certainty; laboratory tests simply confirm the
diagnosis.
– Many times, signs and symptoms of periprosthetic
infection overlap those of hematoma formation,
aseptic loosening, and instability; thus, additional
diagnostic tests are often required
7. B- imaging studies:
1- x-ray signs:
1.- Periosteal reaction.
2.Scattered foci of osteolysis .
3.Generalized bone resorption in absence of implant
wear.
8.
9.
10. C-blood tests
• Erythrocyte sedimentation rate (ESR) and C-
reactive protein (CRP) are nonspecific markers.
• Combined, ESR and CRP have a sensitivity of 99%
and a specificity of 89%.
• Continued elevation of levels of CRP and ESR is
concerning for infection.
• Interleukin-6 may be useful for diagnosis and for
monitoring the progress of infection
11. D-Joint aspiration
• Joint aspiration is performed when there is a
strong suspicion of infection.
• Aspiration has a sensitivity of 57% to 93% and
a specificity of 88% to 100%. Sensitivity can be
improved by repeat aspiration.
12. Type Presentation Definition Treatment
I
Acute postoperative
infection
Acute infection within
first month
Attempt at débridement
and prosthetic retention
II
Late chronic
infection
Chronic indolent
infection presenting >1
month after surgery
Prosthetic removal
III
Acute
hematogenous
infection
Acute onset of
symptoms in a
previously well-
functioning joint
Attempt at débridement
and prosthetic retention,
or prosthetic removal
IV
Positive
intraoperative
cultures
Two or more positive
intraoperative cultures
Appropriate antibiotics
Classification of Periprosthetic Joint Infections
13. -Treatment options
1.Surgical
1.Débridement with retention of prosthesis
2.Resection arthroplasty with reimplantation
3.Definitive resection arthroplasty with or without
arthrodesis
4.Amputation
2.Nonsurgical—Suppressive antimicrobial therapy
14. 1.Two-stage replacement arthroplasty—Two-
stage resection and replacement arthroplasty
is the gold standard for treatment of infection
beyond 4 weeks.
1.Procedure
1.Removal of prosthesis
2.Surgical débridement of the joint
3.Administration of antimicrobials with subsequent
delayed reimplantation
15. • The time interval between the two surgical procedures is
highly variable.
• No specific protocol is in place, but early reimplantation has
less success.
• In infected total knee arthroplasty, reimplantation within 2
weeks has a success rate of approximately 35% compared
to success rates of 70% to 90% with delayed reimplantation
(>6 weeks) and more extensive antimicrobial therapy.
• The proper timing of reimplantation after parenteral
antibiotic therapy should be based on the clinical
appearance of the wound and improvement in serologic
markers of infection, such as the CRP level and the ESR.
16. 2.One-stage replacement arthroplasty
1.Procedure
1.All prosthetic components, infected bone, and soft
tissue are excised.
2.The new prosthesis is implanted during the same
surgery.
3.Intravenous antibiotics are administered for a variable
period of time after the revision
2.Indications
1.Mainly for managing infected hip prostheses
2.Used more commonly in Europe
17. – Advantages
• Single procedure
• Lower cost
• Earlier mobility
• Patient convenience
– Disadvantage
– Risk of reinfection from residual microorganisms
18. 3.Débridement with retention of prosthesis
1. Procedure
1. Débridement of infected tissue and exchange of polyethylene insert
with large-volume irrigation
2. Prolonged postoperative antibiotic therapy
2. Indications—Considered when infection developed within 4
weeks of surgery or after an inciting event such as dental
extraction.
3. Advantages
Limited surgery with preservation of prosthesis and bone stock.
4.Disadvantages
1. Risk of leaving infected foreign body in place
2. Failure rate is generally approximately 20%, with occasional reports of
success up to 85%, depending on the outcome factors listed above.
19. 4.Resection arthroplasty
1. Procedure
1.Definitive removal of all infected components and tissue
2.No subsequent implantation
2. Indications—Currently are limited, but include the
following:
1.Poor quality of bone and soft tissue
2.Recurrent infections
3.Infection with multi-drug-resistant organism
4.Medical conditions that preclude major surgery (reimplantation)
5.Failure of multiple previous exchange arthroplasties
6.Also an acceptable alternative in elderly nonambulatory patients
21. VI. Nonsurgical Treatment
1.Treatment—Suppressive antimicrobial therapy.
2.Indications—Considered for frail, elderly, and ill
patients in whom surgery is not possible or is
refused by the patient.
3.Goals
1.Provide symptomatic relief
2.Maintain joint function
3.Prevent systemic spread of infection rather than
eradication of infection
4.Outcomes
1.Success rates of only 10% to 25%
2.Complications occur in 8% to 22% of patients.