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

初次全膝关节置换术后假体关节感染：发生率、微生物学和危险因素

• 批准号: 10463223
• 负责人: Erica Weinstein
• 金额: $ 7.89万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10463223
• 关键词: Address; Age-Years; Aging; Algorithms; Americas; Anemia; Antibiotic Therapy; Antibiotics; Arthralgia; Award; Bacillus; Biometry; Chronic; Clinical; Clinical Practice Guideline; Communicable Diseases; Complication; Data; Development; Diabetes Mellitus; Economic Burden; Epidemiologist; Epidemiology; Frequencies; Functional disorder; Future; Genitourinary system; Genus staphylococcus; Goals; Healthcare Systems; Heart failure; Hematogenous; Hemorrhage; Hypoalbuminemia; Incidence; Infection; Integrated Health Care Systems; Intervention; Joint Prosthesis; K-Series Research Career Programs; Knowledge; Medical Records; Medicare; Mentors; Mentorship; Microbiology; Monitor; Morbidity - disease rate; Obesity; Operative Surgical Procedures; Organism; Orthopedic Surgery; Outcome; Patient risk; Patients; Pennsylvania; Perioperative; Population; Postoperative Period; Predisposition; Prevalence; Procedures; Publishing; Replacement Arthroplasty; Reporting; Research Personnel; Research Training; Rheumatism; Risk; Risk Factors; Sampling; Skin; Societies; Streptococcus; Subgroup; Surgical incisions; Time; Tobacco use; Training; Transfusion; Trauma; United States; Universities; Veterans Health Administration; antimicrobial; beneficiary; bone; career development; case finding; clinical center; clinical epidemiology; cohort; commensal bacteria; gastrointestinal; high risk; infection burden; infection rate; infection risk; insurance claims; joint infection; knee replacement arthroplasty; prevent; secondary analysis; skills; surgical risk

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.

建议书摘要 全膝关节置换术(TKA)是美国最常见的手术之一。 假体关节感染(Pji)是该手术最严重的并发症，患者的发病率很高。 并给医疗体系带来了巨大的经济负担。尽管将军澳地区经常进行将军澳行动 美国和产后感染的不利影响、发病率、涉及的微生物和危险因素 在TKA之后，PJI的发展在美国仍然未知。 为了开始解决这些知识差距，我们将召集接受全膝关节置换术的全国患者队列 在退伍军人健康管理局(VA)内，这是美国最大的综合医疗系统。在我们的第一个目标， 我们将在TKA术后第一年内确定PJI的发生率和微生物学，并将结果与 术后一年以上发生PJI者。我们将比较这两个时间段的结果 因为关节置换术后12个月的感染通常是由于皮肤的引入引起的 和共生细菌进入手术切口，而感染发生 关节置换后12个月的通常是由血源性播种或局部创伤引起的。这一目标将 确定PJI发生率最高的时间段，进一步加深我们对这些疾病的病理生理学的理解 并将为在这两个时期发展的PJI选择经验性抗生素治疗提供参考。 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，而不考虑PJI的时间 在二次分析中，我们将探索早期和晚期的风险因素是否存在差异 PJI。这一目标将评估风险因素关联的相对强度，这将指导未来的干预 以降低PJI费率。 这些结果将有助于确定TKA术后PJI风险最高的时间，确定TKA的亚组 PJI高危患者进行更密切的监测，并告知临床医生经验性的抗生素治疗决定 在疑似PJI期间。此外，该奖项提供的培训将为申请者提供重要的技能 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。