Abstract
Due to the rise in prosthetic joint implantations, prosthetic joint infections (PJI) are increasing. Most PJI are treated outside the hospital setting via community-based parenteral antiinfective therapy (CoPAT) after initial surgical management, although little is reported about the short-term complications of CoPAT. We therefore ascertained the numbers of unanticipated readmissions, unplanned surgeries, and CoPAT complications within 12 weeks of hospital discharge in patients with PJI on CoPAT. We retrospectively reviewed the charts of 74 patients with PJI. Twenty-seven (73% of readmitted patients) were for unanticipated reasons within 12 weeks of hospital discharge; 16 (43% of readmitted) underwent an unplanned surgery. Nine patients (12% of total cohort) had CoPAT-related adverse events. Our data suggest patients with PJI on CoPAT represent a complex cohort that needs to be monitored closely for complications early after hospital discharge.
Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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References
American Academy of Orthopaedic Surgeons. Information about Orthopaedic Patients and Conditions. Available at: http://www.aaos.org/Research/stats/patientstats.asp. Accessed July 9, 2008.
Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Ilstrup DM, Harmsen WS, Osmon DR. Risk factors for prosthetic joint infection: Case-control study. Clin Infect Dis. 1998;27:1247–1254.
Chary A, Tice AD, Martinelli LP, Liedtke LA, Plantenga MS, Strausbaugh LJ. Experience of infectious diseases consultants with outpatient parenteral antimicrobial therapy: Results of an emerging infections network survey. Clin Infect Dis. 2006;43:1290–1295.
Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350:1422–1429.
Esposito S, Leone S, Noviello S, Ianniello F, Fiore M, Russo M, Foti G, Carpentieri MS, Cellesi C, Zanelli G, Cellini A, Girmenia C, De Lalla F, Maiello A, Maio P, Marranconi F, Sabbatani S, Pantaleoni M, Ghinelli F, Soranzo ML, Vigano P, Re T, Viale P, Scudeller L, Scaglione F, Vullo V. Outpatient parenteral antibiotic therapy for bone and joint infections: An Italian multicenter study. J Chemother. 2007;19:417–422.
Lindberg HO, Carlsson AS, Gentz CF, Pettersson H. Recurrent and non-recurrent dislocation following total hip arthroplasty. Acta Orthop Scand. 1982;53:947–952.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A. Acute kidney injury network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.
Navarro VJ, Senior JR. Drug-related hepatotoxicity. N Engl J Med. 2006;354:731–739.
Sperling JW, Kozak TK, Hanssen AD, Cofield RH. Infection after shoulder arthroplasty. Clin Orthop Relat Res. 2001;382:206–216.
Steckelberg JM, Osmon DR. Prosthetic joint infections. In: Waldvogel FA, Bisno AL. Infections Associated with Indwelling Medical Devices, 3rd Ed. Washington, DC: ASM Press; 2000:173–177.
Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med. 2004:117:556–562.
Vaughn BK. Managing chronic dislocated total hip arthroplasty. Semin Arthroplasty. 1993;4:16–24.
Widmer AF. New developments in diagnosis and treatment of infection in orthopedic implants. Clin Infect Dis. 2001;33 Suppl 2:S94–S106.
Wroblewski BM, Siney PD, Fleming PA. Charnley low-frictional torque arthroplasty in patients under the age of 51 years Follow-up to 33 years. J Bone Joint Surg Br 2002;84:540–543.
Zhan C, Kaczmarek R, Loyo-Berrios N, Sangl J, Bright RA. Incidence and short-term outcomes of primary and revision hip replacement in the United States. J Bone Joint Surg Am. 2007;89:526–533.
Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351:1645–1654.
Acknowledgments
We thank Nabin K. Shrestha MD, MPH, Carlos M. Isada, MD, Steven M. Gordon, MD, David van Duin, MD (Department of Infectious Disease, Cleveland Clinic), and Viktor Krebs, MD, Robert Molloy, MD, and Ulf Knothe, MD (Department of Orthopedic Surgery, Section of Adult Reconstruction, Cleveland Clinic) for their input and advice.
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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
Appendix 1
Appendix 1
Phone script
Hello Mr/Ms…..
This is Dr Duggal calling from the Cleveland Clinic, Department of Infectious Disease. We are doing a research study to see how patients with bone and joint infections do after discharge from the hospital on IV antibiotics. You are receiving this call because you were recently treated for an infection by the Department of Infectious Disease. The study involves answering a few questions regarding your____infection. This will take approximately 5 minutes. Your participation in this study is completely voluntary. If you choose not to participate in the research your care at the Cleveland Clinic will not be affected in any way. Would you agree to participate in the research by answering a few questions?
Is this a good time?
[if no: ‘‘Thank you very much for your time’’]
[If yes: phone interviewer will go through items 1–4]
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1.
As you would recollect, you had an infection in_____ joint/bone while at Cleveland Clinic, and you were discharged on intravenous antibiotics. Have you had any surgery on the same_____joint/bone since your last infectious disease or surgery follow up visit?
[if no, go to next question]
[if yes, obtain date of surgery, hospital where surgery was performed]
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2.
Have you been admitted to a hospital other than the Cleveland Clinic for any reason since your last infectious disease or surgery follow up visit?
[if no, go to next question]
[if yes, obtain date, reason for admission, name of hospital]
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3.
Have you had any more infection(s) of the______ joint/bone for which you were treated by Cleveland Clinic Infectious Disease physician?
[if no, go to next question]
[if yes, obtain date of diagnosis, name of treating physician, antibiotic used, length of treatment, name of
the germ which caused the infection]
-
4.
Since your last infectious disease or surgery follow up, have you had any clotting or infection of the long-term intravenous line placed to give the antibiotics?
[if no, go to end message]
[if yes, date of clotting or infection, name of hospital]
Thank you so much for answering these questions.
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Duggal, A., Barsoum, W. & Schmitt, S.K. Patients with Prosthetic Joint Infection on IV Antibiotics are at High Risk for Readmission. Clin Orthop Relat Res 467, 1727–1731 (2009). https://doi.org/10.1007/s11999-009-0825-7
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DOI: https://doi.org/10.1007/s11999-009-0825-7