Prosthetic Joint Infection After Primary Total Knee Arthroplasty: Incidence, Microbiology and Risk Factors

提案摘要 全膝关节置换术（TKA）是美国最常见的手术之一。 人工关节感染（PJI）是人工关节置换术最严重的并发症，发病率高 给医疗系统带来巨大的经济负担。尽管在美国进行TKA的频率较高， 美国和PJIs的不良影响、发生率、与这些感染有关的微生物和风险因素 在美国，TKA后PJI的发生率尚不清楚。 为了开始解决这些知识差距，我们将组建一个接受TKA的全国患者队列 退伍军人健康管理局（VA）是美国最大的综合卫生系统。我们的第一个目标， 我们将确定TKA术后第一年内PJI的发病率和微生物学，并将结果与 TKA术后一年以上发生PJI的患者。我们将比较这两个时间段的结果 因为在关节置换后<12个月内发生的感染通常是由于皮肤的引入 在手术过程中或手术后不久， 关节置换术后12个月内出血通常是由于血行播散或局部创伤引起的。这一目标将 确定PJI发病率最高的时间段，进一步了解这些疾病的病理生理学。 感染，并将告知在这两个时期内发生的PJI的经验性抗生素治疗的选择。 在我们的第二个目标中，我们将评估与PJI相关的宿主和手术因素，无论PJI发生的时间如何。 在二次分析中，我们将探讨早期和晚期之间的风险因素是否存在差异。 PJI这一目标将评估风险因素之间关联的相对强度，从而指导今后的干预措施 降低PJI费率。 这些结果将有助于确定TKA后PJI最高风险的时间，识别TKA的亚组 对PJI风险最高的患者进行更密切的监测，并告知临床医生经验性抗生素治疗决定 在疑似PJI期间此外，该奖项提供的培训将为申请人提供重要的技能， 她发展成为一名传染病流行病学家，目标是成为一名独立的 调查员拟议的培训计划包括高级流行病学和生物统计学课程， 宾夕法尼亚大学临床流行病学和生物统计学中心，以及 流行病学、生物统计学、传染病和整形外科的研究人员。

PROPOSAL SUMMARY Total knee arthroplasty (TKA) is one of the most common surgeries performed in the United States (US). Prosthetic joint infections (PJI) are the most serious complication of this procedure, with high morbidity to patients and a large economic burden to the healthcare system. Despite the frequency of TKAs being performed in the US and the adverse impact of PJIs, the incidence, organisms implicated in these infections, and the risk factors for development of PJI after TKA remain unknown in the US. To begin to address these knowledge gaps, we will assemble a national cohort of patients who underwent TKA within the Veterans Health Administration (VA), the largest integrated health system in the US. In our first aim, we will determine the incidence and microbiology of PJI within the first year after TKA and compare results to those who develop PJI more than a year after TKA. We will compare results across these two time periods because infections developing <12 months after joint replacement typically arise from the introduction of skin and commensal bacteria into the surgical incision during or shortly after the surgery, whereas infections occurring 12 months after joint replacement typically arise from hematogenous seeding or local trauma. This aim will identify the time period of highest PJI incidence, furthering our understanding of the pathophysiology of these infections, and will inform the choice of empiric antibiotic therapy for PJI that develop during these two periods. In our second aim, we will evaluate host and surgical factors associated with PJI, regardless of the time that PJI developed; in a secondary analysis, we will explore if there are differences in risk factors between early and late PJI. This aim will assess the relative strength of association of risk factors, which will guide future interventions to reduce PJI rates. These results will help determine the timing of highest risk of PJI after TKA, identify the subgroups of TKA patients at highest risk for PJI for closer monitoring, and inform clinicians’ empiric antibiotic treatment decisions during suspected PJI. In addition, the training provided by this award will afford the applicant with skills important for her development into an infectious diseases epidemiologist, with the goal of becoming an independent investigator. The proposed training plan includes advanced epidemiologic and biostatistical coursework in the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania, as well as mentorship from researchers in epidemiology, biostatistics, infectious diseases, and orthopedic surgery.