To report on a 30-year prospective study of deep infection in 1993 consecutive total hip arthroplasties performed by a single surgeon.
The relations of numerous variables to the incidence of deep infection were studied.
The cumulative infection rate after the index total hip arthroplasties rose from 0.8% at 2 years to 1.4% at 20 years; 9.6% of the index operations required further surgery. When infections attributed to these secondary procedures were included, the infection rate rose from 0.9% at 2 years to 2% at 20 years. Although the usual variables increased the incidence of infection, the significant and most precise predictors of infection were radiologic diagnoses of upper pole grade III and protrusio acetabuli, an elevated erythrocyte sedimentation rate, alcoholism and units of blood transfused.
From 2-20 years, the incidence of deep infection doubled. Preoperative recognition of the first 4 risk factors permits the use of additional prophylactic measures. Spinal or epidural anesthesia reduced the units of blood transfused (the fifth risk factor) and, hence, the risk of infection. Although most deep infections are seeded while the wound is open, there are many possible postoperative causes. In this study, fewer than one-third of the infections that presented after 2 years were related to hematogenous spread. The efficacy of clean air technology was supported, and it is recommended that all measures that may reduce the incidence of deep infection be employed.
Cites: J Bone Joint Surg Br. 1982;64(5):568-97142263
International studies show that children in day care centres have approximately twice as many episodes of infectious diseases as children cared for at home, while, according to most studies, children in family day care experience an intermediate number of infections. After some months in day care the risk of infection decreases. The diseases in question are usually transferred from person to person through close physical contact. Children's general mode of behaviour tends to favour such transmission. The risk of infection in pregnant women on the day care staff and among parents is considered. Finally, the author discusses the potential to control infection in a day care setting. Strict rules for isolation of sick children probably have little effect on the spread of the infections. Good routines for washing hands and for changing nappies are considered to be the most important ways of controlling infection in day care centres.
Climate changes will likely have an impact on the spectrum of infectious diseases in Europe. We may see an increase in vector-borne diseases, diseases spread by rodents such as Hantavirus, and food- and water-borne diseases. As the effects of climate changes are likely to occur gradually, a modern industrialised country such as Denmark will have the opportunity to adapt to the expected changes.
Peritonitis in continuous ambulatory peritoneal dialysis (CAPD): a multi-centre randomized clinical trial comparing the Y connector disinfectant system to standard systems. Canadian CAPD Clinical Trials Group.
Sixty-one new continuous ambulatory peritoneal dialysis (CAPD) patients were allocated to a Y connector-disinfectant (Amuchina, Italy) and 63 to standard systems (Baxter Systems II & III) in a randomized clinical trial addressing peritonitis rates in 8 CAPD programs in 6 Canadian cities. In the Y connector-disinfectant group, 15 patients experienced 21 episodes of peritonitis in 452 15 patients experienced 21 episodes of peritonitis in 452 patient-months or 1 per 21.53 patient-months. In the standard systems group, 30 patients experienced 47 episodes of peritonitis in 467 patient-months or 1 per 9.93 patient-months (p = 0.009). The peritonitis risk reduction was 61% (95% confidence limits 27-79%). Exit-site infections occurred in 36% of each group. Prior to the development of exit-site infection, the monthly risk for peritonitis was 3.12% for the Y connector disinfectant system and 7.37% for the standard system. After an exit-site infection, these probabilities increased to 6.15% and 15.47%, respectively. Skin organisms were responsible for peritonitis in 8/21 (38%) in the Y connector-disinfectant group and 30/47 (64%) in the standard group. There were 75 days hospitalized for peritonitis in the Y connector-disinfectant group compared to 257 days for the standard group. The Y connector disinfectant system decreases the peritonitis rate through its effect on skin organisms. Exit-site injections are a major source of organisms responsible for peritonitis.
To identify risk factors associated with the development of surgical-site infection (SSI) following total knee arthroplasty (TKA).
A case-control study.
A 1,100-bed, university-affiliated, tertiary-care teaching hospital.
Case-patients with SSI occurring up to 1 year following primary TKA performed between January 1999 and December 2001 were identified prospectively by infection control practitioners using National Nosocomial Infections Surveillance (NNIS) System methods. Three control-patients were selected for each case-patient, matched by date of surgery. Stepwise logistic regression analysis was used to determine the relation of potential risk factors to the development of infection.
Twenty-two patients with infections (6 superficial and 16 deep) were identified. Infection rates per year were 0.95%, 1.07%, and 1.19% in 1999, 2000, and 2001, respectively. Logistic regression analysis identified two variables independently associated with the development of infection: the use of closed suction drainage (odds ratio [OR], 7.0; 95% confidence interval [CI95], 2.1-25.0; P = .0015) and increased international normalized ratio (INR) (OR, 2.4; CI95, 1.1-5.7; P = .035). Factors not statistically associated with the development of infection included age, NNIS System risk index score, presence of various comorbidities, surgeon, duration of procedure or tourniquet time, type of bone cement or prosthesis used, or receipt of blood product transfusions.
The use of closed suction drainage and a high postoperative INR were associated with the development of SSI following TKA. Avoiding the use of surgical drains and careful monitoring of anticoagulant prophylaxis in patients undergoing TKA should reduce the risk of infection.