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Deep Infection after Total Hip Replacement: A Method for National Incidence Surveillance

Published online by Cambridge University Press:  10 May 2016

Viktor Lindgren ,
Max Gordon ,
Per Wretenberg ,
Johan Kärrholm  and
Göran Garellick
Viktor Lindgren*
Affiliation:
Department of Molecular Medicine and Surgery, Section of Orthopaedics, Karolinska Institutet, Stockholm, Sweden Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, Gothenburg, Sweden
Max Gordon
Affiliation:
Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, Gothenburg, Sweden Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
Per Wretenberg
Affiliation:
Department of Molecular Medicine and Surgery, Section of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
Johan Kärrholm
Affiliation:
Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, Gothenburg, Sweden Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Göran Garellick
Affiliation:
Swedish Hip Arthroplasty Register, Registercentrum Västra Götaland, Gothenburg, Sweden Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
*
Department of Orthopaedics, Karolinska University Hospital, Solna, SE-171 76 Stockholm, Sweden (viktor.lindgren@karolinska.se).
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Abstract

Objective.

The purpose of this study was to estimate the incidence of deep periprosthetic joint infections (PJIs) after primary total hip replacement (THR) in Sweden prior to the introduction of a national initiative to reduce these infections.

Design.

Prospective open cohort study with 2 years follow-up of each subject.

Setting.

All THR-performing clinics in Sweden.

Methods.

All patients registered for a primary THR in the Swedish Hip Arthroplasty Register between July 1, 2005, and December 31, 2008, were selected for the study (45,531 patients with 49,219 THRs) and were matched with the Swedish Prescribed Drug Register. All patients with a minimum of 4 weeks of continuous outpatient antibiotic treatment within 2 years after their primary THR (1,989 patients with 2,219 THRs) were selected for a medical records review, and the number of cases with PJI was determined.

Results.

The cumulative incidence of PJI within 2 years after primary THR was 0.9% (95% confidence interval, 0.85–1.02; n = 443), and 405 of these had been reoperated. The incidence rate of PJI for the first 3 months was 5 per 10,000 THR-weeks and, thereafter, 0.3 per 10,000 THR-weeks. Staphylococcus aureus and coagulase-negative staphylococci were the most common bacteria isolated.

Conclusions.

This study describes a new method of national postoperative infection surveillance. The incidence is similar to previous smaller reports and is useful for monitoring changes over time to evaluate the national initiative to reduce infections.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 12 , December 2014 , pp. 1491 - 1496
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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