Prevention of Periprosthetic Joint Infection (PJI) : A Clinical Practice Protocol in High-Risk Patients
Iannotti, Ferdinando (Università degli Studi di Roma "La Sapienza")
Prati, Paolo (ASST Bergamo Ovest, Ospedale Treviglio)
Fidanza, Andrea (Stanford University School of Medicine)
Iorio, Raffaele (Università degli Studi di Roma "La Sapienza")
Ferretti, Andrea (Università degli Studi di Roma "La Sapienza")
Pérez-Prieto, Daniel (Hospital del Mar (Barcelona, Catalunya))
Kort, Nanne (CortoClinics, Schijndel, The Netherlands)
Violante, Bruno (Istituto Clinico Sant'Ambrogio IRCCS Galeazzi, Milan)
Pipino, Gennaro (Ospedali Privati Riuniti Villa Regina, Bologna)
Schiavone Panni, Alfredo (University of Campania "Luigi Vanvitelli", Napoli)
Hirschmann, Michael (Kantonsspital Baselland, Bruderholz)
Mugnaini, Marco (Ospedale Santa Maria Annunziata Asl Toscana Centro, Firenze)
Indelli, Pier Francesco (Stanford University School of Medicine)
Universitat Autònoma de Barcelona

Date:	2020
Abstract:	Background: Periprosthetic joint infection (PJI) represents 25% of failed total knee arthroplasties (TKA). The European Knee Associates (EKA) formed a transatlantic panel of experts to perform a literature review examining patient-related risk factors with the objective of producing perioperative recommendations in PJI high-risk patients. Methods: Multiple databases (Pubmed/MEDLINE, EMBASE, Scopus, Cochrane Library) and recommendations on TKA PJI prevention measures from the International Consensus Meetings on PJI from the AAOS and AAHKS were reviewed. This represents a Level IV study. Results: Strong evidence was found on poor glycemic control, obesity, malnutrition, and smoking being all associated with increased rates of PJI. In the preoperative period, patient optimization is key: BMI < 35, diet optimization, Hemoglobin A1c < 7. 5, Fructosamine < 292 mmol/L, smoking cessation, and MRSA nasal screening all showed strong evidence on reducing PJI risk. Intraoperatively, a weight-based antibiotic prophylaxis, accurate fluid resuscitation, betadine and chlorhexidine dual skin preparation, diluted povidone iodine solution irrigation, tranexamic acid administration, and monofilament barbed triclosan-coated sutures for soft tissues closure all represented effective prevention measures. In the postoperative period, failure to reach normalization of ESR, CRP, D-dimer, and IL-6 six weeks postoperatively suggested early PJI. Conclusion: The current recommendations from this group of experts, based on published evidence, support risk stratification to identify high-risk patients requiring implementation of perioperative measures to reduce postoperative PJI.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article de revisió ; Article ; Versió publicada
Subject:	TKA ; PJI ; Periprosthetic joint infections ; Knee ; Hip ; Infection ; Prevention ; DAPRI ; Musculoskeletal infections ; Local delivery ; Septic loosening
Published in:	Tropical medicine and infectious disease, Vol. 5 (december 2020) , ISSN 2414-6366

DOI: 10.3390/tropicalmed5040186
PMID: 33322463

12 p, 304.2 KB

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