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.

Prevention of periprosthetic joint infection (PJI): a clinical practice protocol in high-risk patients / Iannotti, Ferdinando; Prati, Paolo; Fidanza, Andrea; Iorio, Raffaele; Ferretti, Andrea; Pèrez Prieto, Daniel; Kort, Nanne; Violante, Bruno; Pipino, Gennaro; Schiavone Panni, Alfredo; Hirschmann, Michael; Mugnaini, Marco; Francesco Indelli, Pier. - In: TROPICAL MEDICINE AND INFECTIOUS DISEASE. - ISSN 2414-6366. - 5:4(2020), pp. 1-12. [10.3390/tropicalmed5040186]

Prevention of periprosthetic joint infection (PJI): a clinical practice protocol in high-risk patients

Iannotti, Ferdinando;Fidanza, Andrea;Iorio, Raffaele;Ferretti, Andrea;
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.
2020
DAPRI; PJI; TKA; hip; infection; knee; local delivery; musculoskeletal infections; periprosthetic joint infections; prevention; septic loosening
01 Pubblicazione su rivista::01g Articolo di rassegna (Review)
Prevention of periprosthetic joint infection (PJI): a clinical practice protocol in high-risk patients / Iannotti, Ferdinando; Prati, Paolo; Fidanza, Andrea; Iorio, Raffaele; Ferretti, Andrea; Pèrez Prieto, Daniel; Kort, Nanne; Violante, Bruno; Pipino, Gennaro; Schiavone Panni, Alfredo; Hirschmann, Michael; Mugnaini, Marco; Francesco Indelli, Pier. - In: TROPICAL MEDICINE AND INFECTIOUS DISEASE. - ISSN 2414-6366. - 5:4(2020), pp. 1-12. [10.3390/tropicalmed5040186]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1510025
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