Obese patients have higher rates of polymicrobial and Gram-negative early periprosthetic joint infections of the hip than non-obese patients
Obese patients are more likely to develop periprosthetic joint infection (PJI) after primary total joint arthroplasty. This study compared the clinical and microbiological characteristics of non-obese, obese and severely obese patients with early PJI, in order to ultimately optimize antibiotic proph...
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| Veröffentlicht in: | PloS one 2019-04, Vol.14 (4), p.e0215035-e0215035 |
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| creator | Löwik, Claudia A M Zijlstra, Wierd P Knobben, Bas A S Ploegmakers, Joris J W Dijkstra, Baukje de Vries, Astrid J Kampinga, Greetje A Mithoe, Glen Al Moujahid, Aziz Jutte, Paul C Wouthuyzen-Bakker, Marjan |
| description | Obese patients are more likely to develop periprosthetic joint infection (PJI) after primary total joint arthroplasty. This study compared the clinical and microbiological characteristics of non-obese, obese and severely obese patients with early PJI, in order to ultimately optimize antibiotic prophylaxis and other prevention measures for this specific patient category.
We retrospectively evaluated patients with early PJI of the hip and knee treated with debridement, antibiotics and implant retention (DAIR) between 2006 and 2016 in three Dutch hospitals. Only patients with primary arthroplasties indicated for osteoarthritis were included. Early PJI was defined as an infection that developed within 90 days after index surgery. Obesity was defined as a BMI ≥30kg/m2 and severe obesity as a BMI ≥35kg/m2.
A total of 237 patients were analyzed, including 64 obese patients (27.0%) and 62 severely obese patients (26.2%). Compared with non-obese patients, obese patients had higher rates of polymicrobial infections (60.3% vs 33.3%, p |
| doi_str_mv | 10.1371/journal.pone.0215035 |
| format | Article |
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We retrospectively evaluated patients with early PJI of the hip and knee treated with debridement, antibiotics and implant retention (DAIR) between 2006 and 2016 in three Dutch hospitals. Only patients with primary arthroplasties indicated for osteoarthritis were included. Early PJI was defined as an infection that developed within 90 days after index surgery. Obesity was defined as a BMI ≥30kg/m2 and severe obesity as a BMI ≥35kg/m2.
A total of 237 patients were analyzed, including 64 obese patients (27.0%) and 62 severely obese patients (26.2%). Compared with non-obese patients, obese patients had higher rates of polymicrobial infections (60.3% vs 33.3%, p<0.001) with more often involvement of Enterococcus species (27.0% vs 11.7%, p = 0.003). Moreover, severely obese patients had more Gram-negative infections, especially with Proteus species (12.9% vs 2.3%, p = 0.001). These results were only found in periprosthetic hip infections, comprising Gram-negative PJIs in 34.2% of severely obese patients compared with 24.7% in obese patients and 12.7% in non-obese patients (p = 0.018).
Our results demonstrate that obese patients with early periprosthetic hip infections have higher rates of polymicrobial infections with enterococci and Gram-negative rods, which stresses the importance of improving preventive strategies in this specific patient category, by adjusting antibiotic prophylaxis regimens, improving disinfection strategies and optimizing postoperative wound care.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0215035</identifier><identifier>PMID: 30958847</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Alcohol ; Analysis ; Antibiotics ; Arthritis ; Arthroplasty ; Arthroplasty, Replacement, Hip - adverse effects ; Biocompatibility ; Biology and Life Sciences ; Biomedical materials ; Body mass ; Body mass index ; Bone surgery ; Coinfection - complications ; Coinfection - epidemiology ; Coinfection - microbiology ; Coinfection - pathology ; Diabetes ; Disease susceptibility ; Disinfection ; Female ; Gram-Negative Bacterial Infections - epidemiology ; Gram-Negative Bacterial Infections - microbiology ; Gram-Negative Bacterial Infections - pathology ; Health aspects ; Hip ; Hip Joint - surgery ; Hospitals ; Humans ; Incidence ; Infection ; Infections ; Infectious diseases ; Joint diseases ; Joint surgery ; Joints (anatomy) ; Knee ; Male ; Medicine and Health Sciences ; Microbiology ; Microorganisms ; Middle Aged ; Netherlands - epidemiology ; Obesity ; Obesity - complications ; Obesity - microbiology ; Obesity - pathology ; Optimization ; Orthopedic surgery ; Osteoarthritis ; Overweight persons ; Patients ; Povidone ; Prevention ; Prophylaxis ; Prostheses ; Prosthesis-Related Infections - complications ; Prosthesis-Related Infections - epidemiology ; Prosthesis-Related Infections - microbiology ; Prosthesis-Related Infections - pathology ; Retrospective Studies ; Risk factors ; Rods ; Skin ; Staphylococcus infections ; Surgery ; Surgical implants ; Wound care ; Wounds</subject><ispartof>PloS one, 2019-04, Vol.14 (4), p.e0215035-e0215035</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Löwik et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Löwik et al 2019 Löwik et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c758t-5b2d398ed87e77cad00110ac3b50bfa8fa3b1d5ab6ee7f39fce623497c0d2213</citedby><cites>FETCH-LOGICAL-c758t-5b2d398ed87e77cad00110ac3b50bfa8fa3b1d5ab6ee7f39fce623497c0d2213</cites><orcidid>0000-0002-3532-537X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453483/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453483/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,865,886,2103,2929,23867,27925,27926,53792,53794</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30958847$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Rohde, Holger</contributor><creatorcontrib>Löwik, Claudia A M</creatorcontrib><creatorcontrib>Zijlstra, Wierd P</creatorcontrib><creatorcontrib>Knobben, Bas A S</creatorcontrib><creatorcontrib>Ploegmakers, Joris J W</creatorcontrib><creatorcontrib>Dijkstra, Baukje</creatorcontrib><creatorcontrib>de Vries, Astrid J</creatorcontrib><creatorcontrib>Kampinga, Greetje A</creatorcontrib><creatorcontrib>Mithoe, Glen</creatorcontrib><creatorcontrib>Al Moujahid, Aziz</creatorcontrib><creatorcontrib>Jutte, Paul C</creatorcontrib><creatorcontrib>Wouthuyzen-Bakker, Marjan</creatorcontrib><creatorcontrib>Northern Infection Network Joint Arthroplasty (NINJA)</creatorcontrib><creatorcontrib>for the Northern Infection Network Joint Arthroplasty (NINJA)</creatorcontrib><title>Obese patients have higher rates of polymicrobial and Gram-negative early periprosthetic joint infections of the hip than non-obese patients</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Obese patients are more likely to develop periprosthetic joint infection (PJI) after primary total joint arthroplasty. This study compared the clinical and microbiological characteristics of non-obese, obese and severely obese patients with early PJI, in order to ultimately optimize antibiotic prophylaxis and other prevention measures for this specific patient category.
We retrospectively evaluated patients with early PJI of the hip and knee treated with debridement, antibiotics and implant retention (DAIR) between 2006 and 2016 in three Dutch hospitals. Only patients with primary arthroplasties indicated for osteoarthritis were included. Early PJI was defined as an infection that developed within 90 days after index surgery. Obesity was defined as a BMI ≥30kg/m2 and severe obesity as a BMI ≥35kg/m2.
A total of 237 patients were analyzed, including 64 obese patients (27.0%) and 62 severely obese patients (26.2%). Compared with non-obese patients, obese patients had higher rates of polymicrobial infections (60.3% vs 33.3%, p<0.001) with more often involvement of Enterococcus species (27.0% vs 11.7%, p = 0.003). Moreover, severely obese patients had more Gram-negative infections, especially with Proteus species (12.9% vs 2.3%, p = 0.001). These results were only found in periprosthetic hip infections, comprising Gram-negative PJIs in 34.2% of severely obese patients compared with 24.7% in obese patients and 12.7% in non-obese patients (p = 0.018).
Our results demonstrate that obese patients with early periprosthetic hip infections have higher rates of polymicrobial infections with enterococci and Gram-negative rods, which stresses the importance of improving preventive strategies in this specific patient category, by adjusting antibiotic prophylaxis regimens, improving disinfection strategies and optimizing postoperative wound care.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Alcohol</subject><subject>Analysis</subject><subject>Antibiotics</subject><subject>Arthritis</subject><subject>Arthroplasty</subject><subject>Arthroplasty, Replacement, Hip - adverse effects</subject><subject>Biocompatibility</subject><subject>Biology and Life Sciences</subject><subject>Biomedical materials</subject><subject>Body mass</subject><subject>Body mass index</subject><subject>Bone surgery</subject><subject>Coinfection - complications</subject><subject>Coinfection - epidemiology</subject><subject>Coinfection - microbiology</subject><subject>Coinfection - pathology</subject><subject>Diabetes</subject><subject>Disease susceptibility</subject><subject>Disinfection</subject><subject>Female</subject><subject>Gram-Negative Bacterial Infections - epidemiology</subject><subject>Gram-Negative Bacterial Infections - microbiology</subject><subject>Gram-Negative Bacterial Infections - pathology</subject><subject>Health aspects</subject><subject>Hip</subject><subject>Hip Joint - surgery</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infection</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Joint diseases</subject><subject>Joint surgery</subject><subject>Joints (anatomy)</subject><subject>Knee</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Microbiology</subject><subject>Microorganisms</subject><subject>Middle Aged</subject><subject>Netherlands - epidemiology</subject><subject>Obesity</subject><subject>Obesity - complications</subject><subject>Obesity - microbiology</subject><subject>Obesity - pathology</subject><subject>Optimization</subject><subject>Orthopedic surgery</subject><subject>Osteoarthritis</subject><subject>Overweight persons</subject><subject>Patients</subject><subject>Povidone</subject><subject>Prevention</subject><subject>Prophylaxis</subject><subject>Prostheses</subject><subject>Prosthesis-Related Infections - complications</subject><subject>Prosthesis-Related Infections - epidemiology</subject><subject>Prosthesis-Related Infections - microbiology</subject><subject>Prosthesis-Related Infections - pathology</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Rods</subject><subject>Skin</subject><subject>Staphylococcus infections</subject><subject>Surgery</subject><subject>Surgical implants</subject><subject>Wound care</subject><subject>Wounds</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk1GL1DAQx4so3nn6DUQLgujDrknTpO2LcBx6Lhws6OFrSNtpm6Wb1CQ93O_gh3Z2t3ds5R6kDynJb_7_zGQmil5TsqQso582dnRG9cvBGliShHLC-JPonBYsWYiEsKcn_2fRC-83hHCWC_E8OmOk4HmeZufRn3UJHuJBBQ0m-LhTdxB3uu3AxU4F8LFt4sH2u62unC216mNl6vjaqe3CQIthyINy_S4ewOnBWR86CLqKN1abEGvTQBW0NQchPELxAVdlYmPNws7cX0bPGtV7eDWtF9Ht1y-3V98WN-vr1dXlzaLKeB4WvExqVuRQ5xlkWaVqQiglqmIlJ2Wj8kaxktZclQIga1jRVCASlhZZReokoewienuUHXrr5VRHL5ME61NwJvbE6kjUVm3k4PRWuZ20SsvDhnWtVA6T7EEmgI5FyqlgIi2bphAkSyjB4nJRlaJGrc-T21huoa4wUaf6mej8xOhOtvZOipSzNGco8GEScPbXCD7IrfYV9L0yYMfDvTE9UtAM0Xf_oI9nN1GtwgTwhSz6VntReclzKgqGxkgtH6HwqwF7AZuu0bg_C_g4C0AmwO_QqtF7ufrx_f_Z9c85-_6E7UD1ofO2Hw9dNQfTI4id6r2D5qHIlMj9zNxXQ-5nRk4zg2FvTh_oIeh-SNhfcsET6w</recordid><startdate>20190408</startdate><enddate>20190408</enddate><creator>Löwik, 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patients have higher rates of polymicrobial and Gram-negative early periprosthetic joint infections of the hip than non-obese patients</title><author>Löwik, Claudia A M ; Zijlstra, Wierd P ; Knobben, Bas A S ; Ploegmakers, Joris J W ; Dijkstra, Baukje ; de Vries, Astrid J ; Kampinga, Greetje A ; Mithoe, Glen ; Al Moujahid, Aziz ; Jutte, Paul C ; Wouthuyzen-Bakker, Marjan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c758t-5b2d398ed87e77cad00110ac3b50bfa8fa3b1d5ab6ee7f39fce623497c0d2213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Alcohol</topic><topic>Analysis</topic><topic>Antibiotics</topic><topic>Arthritis</topic><topic>Arthroplasty</topic><topic>Arthroplasty, Replacement, Hip - adverse effects</topic><topic>Biocompatibility</topic><topic>Biology and Life Sciences</topic><topic>Biomedical materials</topic><topic>Body mass</topic><topic>Body mass index</topic><topic>Bone surgery</topic><topic>Coinfection - complications</topic><topic>Coinfection - epidemiology</topic><topic>Coinfection - microbiology</topic><topic>Coinfection - pathology</topic><topic>Diabetes</topic><topic>Disease susceptibility</topic><topic>Disinfection</topic><topic>Female</topic><topic>Gram-Negative Bacterial Infections - epidemiology</topic><topic>Gram-Negative Bacterial Infections - microbiology</topic><topic>Gram-Negative Bacterial Infections - pathology</topic><topic>Health aspects</topic><topic>Hip</topic><topic>Hip Joint - surgery</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infection</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Joint diseases</topic><topic>Joint surgery</topic><topic>Joints (anatomy)</topic><topic>Knee</topic><topic>Male</topic><topic>Medicine and Health 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USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Löwik, Claudia A M</au><au>Zijlstra, Wierd P</au><au>Knobben, Bas A S</au><au>Ploegmakers, Joris J W</au><au>Dijkstra, Baukje</au><au>de Vries, Astrid J</au><au>Kampinga, Greetje A</au><au>Mithoe, Glen</au><au>Al Moujahid, Aziz</au><au>Jutte, Paul C</au><au>Wouthuyzen-Bakker, Marjan</au><au>Rohde, Holger</au><aucorp>Northern Infection Network Joint Arthroplasty (NINJA)</aucorp><aucorp>for the Northern Infection Network Joint Arthroplasty (NINJA)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Obese patients have higher rates of polymicrobial and Gram-negative early periprosthetic joint infections of the hip than non-obese patients</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-04-08</date><risdate>2019</risdate><volume>14</volume><issue>4</issue><spage>e0215035</spage><epage>e0215035</epage><pages>e0215035-e0215035</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Obese patients are more likely to develop periprosthetic joint infection (PJI) after primary total joint arthroplasty. This study compared the clinical and microbiological characteristics of non-obese, obese and severely obese patients with early PJI, in order to ultimately optimize antibiotic prophylaxis and other prevention measures for this specific patient category.
We retrospectively evaluated patients with early PJI of the hip and knee treated with debridement, antibiotics and implant retention (DAIR) between 2006 and 2016 in three Dutch hospitals. Only patients with primary arthroplasties indicated for osteoarthritis were included. Early PJI was defined as an infection that developed within 90 days after index surgery. Obesity was defined as a BMI ≥30kg/m2 and severe obesity as a BMI ≥35kg/m2.
A total of 237 patients were analyzed, including 64 obese patients (27.0%) and 62 severely obese patients (26.2%). Compared with non-obese patients, obese patients had higher rates of polymicrobial infections (60.3% vs 33.3%, p<0.001) with more often involvement of Enterococcus species (27.0% vs 11.7%, p = 0.003). Moreover, severely obese patients had more Gram-negative infections, especially with Proteus species (12.9% vs 2.3%, p = 0.001). These results were only found in periprosthetic hip infections, comprising Gram-negative PJIs in 34.2% of severely obese patients compared with 24.7% in obese patients and 12.7% in non-obese patients (p = 0.018).
Our results demonstrate that obese patients with early periprosthetic hip infections have higher rates of polymicrobial infections with enterococci and Gram-negative rods, which stresses the importance of improving preventive strategies in this specific patient category, by adjusting antibiotic prophylaxis regimens, improving disinfection strategies and optimizing postoperative wound care.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30958847</pmid><doi>10.1371/journal.pone.0215035</doi><tpages>e0215035</tpages><orcidid>https://orcid.org/0000-0002-3532-537X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2019-04, Vol.14 (4), p.e0215035-e0215035 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2205395361 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS) Journals Open Access; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Aged Aged, 80 and over Alcohol Analysis Antibiotics Arthritis Arthroplasty Arthroplasty, Replacement, Hip - adverse effects Biocompatibility Biology and Life Sciences Biomedical materials Body mass Body mass index Bone surgery Coinfection - complications Coinfection - epidemiology Coinfection - microbiology Coinfection - pathology Diabetes Disease susceptibility Disinfection Female Gram-Negative Bacterial Infections - epidemiology Gram-Negative Bacterial Infections - microbiology Gram-Negative Bacterial Infections - pathology Health aspects Hip Hip Joint - surgery Hospitals Humans Incidence Infection Infections Infectious diseases Joint diseases Joint surgery Joints (anatomy) Knee Male Medicine and Health Sciences Microbiology Microorganisms Middle Aged Netherlands - epidemiology Obesity Obesity - complications Obesity - microbiology Obesity - pathology Optimization Orthopedic surgery Osteoarthritis Overweight persons Patients Povidone Prevention Prophylaxis Prostheses Prosthesis-Related Infections - complications Prosthesis-Related Infections - epidemiology Prosthesis-Related Infections - microbiology Prosthesis-Related Infections - pathology Retrospective Studies Risk factors Rods Skin Staphylococcus infections Surgery Surgical implants Wound care Wounds |
| title | Obese patients have higher rates of polymicrobial and Gram-negative early periprosthetic joint infections of the hip than non-obese patients |
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