Skip to main content

Advertisement

SpringerLink
Log in

Clinical and epidemiological differences between implant-associated and implant-free orthopaedic infections

  • Original Article • GENERAL ORTHOPAEDICS - INFECTION
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Although there have been many publications regarding the risk factors for implant-associated orthopaedic infections, none have investigated how clinical presentations and epidemiology may differ between infections with and without osteosynthetic material.

Methods

We pooled clinical data from several databases of adult patients with orthopaedic infections hospitalized at Geneva University Hospitals from January 2004 to December 2014.

Results

Among 2740 episodes of orthopaedic infections, 76% were implant-free osteoarticular or soft tissue infections. Among the 665 (24% of the total episodes) infections that involved osteosynthetic material, 319 (49%) were total joint arthroplasties, 143 single plates, and 50 single nails. The remainders were mixed implant infections, pins, wires, screws, cerclages or spondylodeses. The implant-associated, compared to the implant-free, infections were significantly more frequently associated with female sex, older age, bacteraemia and skin commensal infections, e.g. coagulase-negative staphylococci, corynebacteria or propionibacteria. In contrast, implant-associated infections were significantly less frequently associated with immune suppression, abscess formation, infections due to Staphylococcus aureus or streptococci, polymicrobial pathogens and foot infections. The serum CRP levels at admission were similar (median 82 vs. 75 mg/L).

Conclusions

Compared to implant-free infections, implant-associated orthopaedic infections are more likely monomicrobial, bacteraemic and due to skin commensals. They involve more often female and older patients, but are less often associated with immune suppression, abscess formation and foot infections.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Uçkay I, Pittet D, Vaudaux P, Sax H, Lew D, Waldvogel F (2008) Foreign body infections due to Staphylococcus epidermidis. Ann Med 14:1–11

    Google Scholar 

  2. Al-Mayahi M, Betz M, Müller DA, Stern R, Tahintzi P, Bernard L, Hoffmeyer P, Suvà D, Uçkay I (2013) Remission rate of implant-related infections following revision surgery after fractures. Int Orthop 37:2253–2258

    Article  PubMed  PubMed Central  Google Scholar 

  3. Trampuz A, Widmer AF (2006) Infections associated with orthopaedic implants. Curr Opin Infect Dis 19:349–356

    Article  CAS  PubMed  Google Scholar 

  4. Bernard L, Hoffmeyer P, Assal M, Vaudaux P, Schrenzel J, Lew D (2004) Trends in the treatment of orthopaedic prosthetic infections. J Antimicrob Chemother 53:127–129

    Article  CAS  PubMed  Google Scholar 

  5. Betz M, Abrassart S, Vaudaux P, Gjika E, Schindler M, Billières J, Zenelaj B, Suvà D, Peter R, Uçkay I (2015) Increased risk of treatment failure in hip prostheses infected with Staphylococcus aureus treated with debridement, antibiotics and implant retention compared to Streptococcus. Int Orthop 39:397–401

    Article  PubMed  Google Scholar 

  6. Uçkay I, Lübbeke A, Emonet S, Tovmirzaeva L, Stern R, Ferry T, Assal M, Bernard L, Lew D, Hoffmeyer P (2009) Low incidence of haematogenous seeding to total hip and knee prostheses in patients with remote infections. J Infect 59:337–345

    Article  PubMed  Google Scholar 

  7. Uçkay I, Hoffmeyer P, Lew D, Pittet D (2013) Prevention of surgical site infections in orthopaedic surgery and bone trauma: state-of-the-art update. J Hosp Infect 84:5–12

    Article  PubMed  Google Scholar 

  8. Henricson A, Skoog A, Carlsson A (2007) The Swedish ankle arthroplasty register: an analysis of 531 arthroplasties between 1993 and 2005. Acta Orthop 78(5):569–574

    Article  PubMed  Google Scholar 

  9. Hosman AH, Mason RB, Hobbs T, Rothwell AG (2007) A New Zealand national joint registry review of 202 total ankle replacements followed for up to 6 years. Acta Orthop 78(5):584–591

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopaedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, University of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland

    Céline Cuérel, Sophie Abrassart, Julien Billières, Domizio Suva, Victor Dubois-Ferrière & Ilker Uçkay

  2. Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, 4, rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland

    Diego Andrey & Ilker Uçkay

Authors
  1. Céline Cuérel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sophie Abrassart
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julien Billières
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Diego Andrey
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Domizio Suva
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Victor Dubois-Ferrière
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ilker Uçkay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Céline Cuérel.

Ethics declarations

Conflict of interest

All the authors have no funding or conflicts of interest to disclose.

Ethical standards

This retrospective study is in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cuérel, C., Abrassart, S., Billières, J. et al. Clinical and epidemiological differences between implant-associated and implant-free orthopaedic infections. Eur J Orthop Surg Traumatol 27, 229–231 (2017). https://doi.org/10.1007/s00590-016-1879-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-016-1879-3

Keywords

Search

Navigation