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Efficacy of universal preoperative decolonization with Polyhexanide in primary joint arthroplasty on surgical site infections. A multicenter before-and after-study

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Název: Efficacy of universal preoperative decolonization with Polyhexanide in primary joint arthroplasty on surgical site infections. A multicenter before-and after-study
Autoři: Björn Wandhoff, Christin Schröder, Ulrich Nöth, Robert Krause, Burkhard Schmidt, Stephan David, Eike-Eric Scheller, Friedrich Jahn, Michael Behnke, Petra Gastmeier, Tobias Siegfried Kramer
Zdroj: Antimicrob Resist Infect Control
Antimicrobial Resistance and Infection Control, Vol 9, Iss 1, Pp 1-9 (2020)
Informace o vydavateli: Springer Science and Business Media LLC, 2020.
Rok vydání: 2020
Témata: Male, 0301 basic medicine, Staphylococcus aureus, Arthroplasty, Replacement, Hip, Biguanides, Infectious and parasitic diseases, RC109-216, 03 medical and health sciences, Decolonization, 0302 clinical medicine, Preoperative Care, Periprosthetic joint infection, Humans, Surgical Wound Infection, Arthroplasty, Replacement, Knee, Aged, 0303 health sciences, Polyhexanide, Research, Middle Aged, 3. Good health, Total joint arthroplasty, Female, Surgical Wound Infection/prevention, Female [MeSH], Staphylococcus aureus/drug effects [MeSH], Preoperative Care [MeSH], Aged [MeSH], Humans [MeSH], Middle Aged [MeSH], Arthroplasty, Replacement, Knee/adverse effects [MeSH], Surgical Wound Infection/epidemiology [MeSH], Male [MeSH], Arthroplasty, Replacement, Hip/adverse effects [MeSH], Biguanides/pharmacology [MeSH], Surgical site infection, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
Popis: Background Surgical site infections (SSI) are rare but severe complications after total joint arthroplasty (TJA). Decolonization measures prior to elective orthopedic surgeries have shown to reduce the risk of SSI with Staphylococcus aureus (S. aureus). Objective To determine the efficacy of universal decolonization with Polyhexanide on SSI rates with a focus on Staphylococcus aureus in patients with TJA. Methods Patients scheduled for elective hip or knee TJA in 5 participating certified orthopedic centers were included between 2015 and 2018 into this before and after study. Data on patients, surgeries and infections were prospectively collected. CDC-criteria were used to define and categorize Infections within 90 days after surgery. From January 2017 on, patients received decolonization sets containing Polyhexanide. Patients performed a 5 day decolonization regimen starting 4 days prior to surgery which included wipes, nasal decontamination and oral solution. Results Thirteen thousand, three hundred fifteen patients received TJA. During intervention 4437 decolonization sets were distributed among 7175 patients. Overall SSI rates increased from 0.68 /100 surgeries to 0.91/ 100 surgeries after implementation of the intervention (IRR 1.32; 95% CI 0.90–1.96). Time series analysis identified an increasing trend of SSI prior to the intervention. After implementation overall SSI rates plateaued. Regression analysis revealed surgery during intervention period to be an independent risk factor for developing a SSI (OR 1.34; 95%CI 1.18–1.53). Initial SSI rates due to S. aureus were 0.24/100 surgeries and decreased to 0.14/100 surgeries (IRR 0.57; 95% CI 0.25–1.22) after introduction of decolonization. Regression analysis revealed surgery during intervention period to be an independent protective factor for developing a SSI with S. aureus (OR 0.57, 95% CI: 0.33–0.99). Overall deep S. aureus SSI decreased significantly from 0.22/100 surgeries to 0.00/100 surgeries in patients adherent to protocol (IRR 0.00, 95% CI 0.00–.85). Conclusion Universal decolonization with Polyhexanide did not reduce overall surgical site infections, but was effective in reducing Staphylococcus aureus - surgical site infections following elective joint arthroplasty. Polyhexanide could extend the list of alternatives to already established decolonization strategies. Trial registration The trial was registered at the German Registry for clinical studies www.drks.de (DRKS00011505).
Druh dokumentu: Article
Conference object
Other literature type
Jazyk: English
ISSN: 2047-2994
DOI: 10.1186/s13756-020-00852-0
DOI: 10.17169/refubium-35348
Přístupová URL adresa: https://aricjournal.biomedcentral.com/track/pdf/10.1186/s13756-020-00852-0
https://pubmed.ncbi.nlm.nih.gov/33256845
https://doaj.org/article/ecdec32d7d1342f2bf53dc7763051987
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708093
https://aricjournal.biomedcentral.com/articles/10.1186/s13756-020-00852-0
https://europepmc.org/article/MED/33256845
https://link.springer.com/content/pdf/10.1186/s13756-020-00852-0.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708093
https://link.springer.com/article/10.1186/s13756-020-00852-0
https://repository.publisso.de/resource/frl:6472146
Rights: CC BY
Přístupové číslo: edsair.doi.dedup.....a3bc1f163fd3470f659c3c8f75146dd8
Databáze: OpenAIRE
Popis
Abstrakt:Background Surgical site infections (SSI) are rare but severe complications after total joint arthroplasty (TJA). Decolonization measures prior to elective orthopedic surgeries have shown to reduce the risk of SSI with Staphylococcus aureus (S. aureus). Objective To determine the efficacy of universal decolonization with Polyhexanide on SSI rates with a focus on Staphylococcus aureus in patients with TJA. Methods Patients scheduled for elective hip or knee TJA in 5 participating certified orthopedic centers were included between 2015 and 2018 into this before and after study. Data on patients, surgeries and infections were prospectively collected. CDC-criteria were used to define and categorize Infections within 90 days after surgery. From January 2017 on, patients received decolonization sets containing Polyhexanide. Patients performed a 5 day decolonization regimen starting 4 days prior to surgery which included wipes, nasal decontamination and oral solution. Results Thirteen thousand, three hundred fifteen patients received TJA. During intervention 4437 decolonization sets were distributed among 7175 patients. Overall SSI rates increased from 0.68 /100 surgeries to 0.91/ 100 surgeries after implementation of the intervention (IRR 1.32; 95% CI 0.90–1.96). Time series analysis identified an increasing trend of SSI prior to the intervention. After implementation overall SSI rates plateaued. Regression analysis revealed surgery during intervention period to be an independent risk factor for developing a SSI (OR 1.34; 95%CI 1.18–1.53). Initial SSI rates due to S. aureus were 0.24/100 surgeries and decreased to 0.14/100 surgeries (IRR 0.57; 95% CI 0.25–1.22) after introduction of decolonization. Regression analysis revealed surgery during intervention period to be an independent protective factor for developing a SSI with S. aureus (OR 0.57, 95% CI: 0.33–0.99). Overall deep S. aureus SSI decreased significantly from 0.22/100 surgeries to 0.00/100 surgeries in patients adherent to protocol (IRR 0.00, 95% CI 0.00–.85). Conclusion Universal decolonization with Polyhexanide did not reduce overall surgical site infections, but was effective in reducing Staphylococcus aureus - surgical site infections following elective joint arthroplasty. Polyhexanide could extend the list of alternatives to already established decolonization strategies. Trial registration The trial was registered at the German Registry for clinical studies www.drks.de (DRKS00011505).
ISSN:20472994
DOI:10.1186/s13756-020-00852-0