Incidência e fatores de risco para infecções de sítio cirúrgico ortopédicas com uso de prótese: coorte não concorrente / Incidence and risk factors for orthopedic surgical site infections with prosthesis: non-concurrent cohort

As cirurgias ortopédicas com uso de prótese são procedimentos utilizados para o tratamento de doenças em articulações. Embora seja um procedimento bastante utilizado, o paciente está sujeito as várias complicações e insucesso do tratamento. Entre essas complicações, a infecção de sítio cirúrgico (ISC) é uma das mais prevalentes, com incidências variando entre 1,4% e 12,6%. Para prevenir essa afecção, o acompanhamento da incidência e a monitorização de fatores de risco permitirão adoções de práticas de prevenção baseadas em evidências, visando uma assistência mais segura. Este estudo é uma coorte não concorrente de 149 pacientes submetidos à artroplastia total de quadril (ATQ) e artroplastia total de joelho (ATJ). O objetivo geral foi analisar os aspectos epidemiológicos das infecções de sitio cirúrgico nos pacientes submetidos à cirurgia ortopédica, no período de 2015 a 2018 em um hospital de grande porte de Belo Horizonte, Minas Gerais. Os objetivos específicos foram estimar a incidência das infecções de sítio cirúrgico; estimar a incidência de infecção de sítio cirúrgico (ISC) por topografia; identificar os fatores de risco associados à infecção ortopédica; identificar os microorganismos responsáveis pelas infecções e propor modelo preditivo multivariado. Na análise univariada, aplicou-se o teste não paramétrico de Mann Whitney. E para verificar a hipótese de associação entre as variáveis categóricas com os grupos, aplicouse o teste exato de Fisher. Na análise multivariada, aplicou-se o modelo de Regressão Logística (p-valor<0,05.) Foram notificadas seis ISC, com taxa global de 4,03%, todas caracterizadas como superficiais. Nos pacientes que foram submetidos à ATJ, a incidência de ISC foi de 2,94% e os que realizaram ATQ, 4,94%. Os fatores de risco identificados para ISC ortopédicas foram idade e hipertensão arterial sistêmica. Os microorganismos isolados foram Enterobacter cloacae, Acinetobacter baumannii e Stenotrophomonas maltophilia. As taxas de ISC encontradas neste estudo foram maiores que as recomendadas pelo NHSN/CDC.(AU)

Orthopedic surgeries with prosthesis are procedures used for the treatment of diseases in joints. Although it is a widely used procedure, the patient is subject to various complications and treatment failure. Among these complications, surgical site infection (SSI) is one of the most common, with incidence varying between 1.4% and 12.6%. To prevent this condition, monitoring incidence and monitoring risk factors will allow adoptions of evidencebased prevention practices for safer care. This study is a non-concurrent cohort of 149 patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The general objective was to analyze the epidemiological aspects of surgical site infections in patients submitted to orthopedic surgery from 2015 to 2018 at a large hospital in Belo Horizonte, Minas Gerais. The specific objectives were to estimate the incidence of surgical site infections; to estimate the incidence of surgical site infection (SSI) by topography; identify the risk factors associated with orthopedic infection; identify the microorganisms responsible for infections and propose a multivariate predictive model. In the univariate analysis, the nonparametric Mann Whitney test was applied. And to verify the hypothesis of association between the categorical variables with the groups, Fisher's exact test was applied. In the multivariate analysis, the Logistic Regression model was applied (p-value <0.05). Six SSIs were reported, with an overall rate of 4.03%, all characterized as superficial. In patients who underwent TKA, the incidence of SSI was 2.94% and those who undergoing TKA, 4.94%. The risk factors identified for orthopedic SSIs were age and systemic arterial hypertension. The isolated microorganisms were Enterobacter cloacae, Acinetobacter baumannii and Stenotrophomonas maltophilia. The SSI rates found in this study were higher than those recommended by the NHSN / CDC.(AU)

Infections after shoulder arthroplasty are correlated with higher anesthetic risk score: a case-control study in Brazil

ABSTRACT Purposes: Shoulder arthroplasty (SA) has been performed by many years for the treatment of several conditions, including osteoarthritis and proximal humeral fractures following trauma. Surgical site infection (SSI) following Shoulder arthroplasty remains a challenge, contributing to increased morbidity and costs. Identification of risk factors may help implementing adequate strategies to prevent infection. We aimed to identify pre- and intra-operative risk factors associated with deep infections after Shoulder arthroplasty. Methods: An unmatched case-control study was conducted to describe the prevalence, clinical and microbiological findings, and to evaluate patient and surgical risk factors for prosthetic shoulder infection (PSI), among 158 patients who underwent SA due to any reason, at a tertiary public university institution. Risk factors for PSI was assessed by uni- and multivariate analyses using multiple logistic regression. Results: 168 SA from 158 patients were analyzed, with an overall infection rate of 9.5% (16/168 cases). Subjects undergoing SA with American Society of Anesthesiologists (ASA) grade III or higher (odds ratio [OR] = 5.30, 95% confidence interval [CI] = 1.58-17.79, p < 0.013) and presenting local hematoma after surgery (odds ratio [OR] = 7.10, 95% confidence interval [CI] = 1.09-46.09, p = 0.04) had higher risk for PSI on univariate analysis. However, only ASA score grade III or higher remained significant on multivariate analysis (OR = 4.74, 95% CI = 1.33-16.92, p = 0.016). Gram-positive cocci and Gram-negative bacilli were equally isolated in 50% of cases; however, the most commonly detected bacterium was Pseudomonas aeruginosa (18.7%). Conclusion: This study provides evidence suggesting that patient-related known factors such as higher ASA score predisposes to shoulder arthroplasty-associated infection. Furthermore, unusual pathogens associated with PSI were identified.