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Effect of a national infection control programme in Sweden on prosthetic joint infection incidence following primary total hip arthroplasty: a cohort study
Örebro University, School of Medical Sciences. Department of Orthopedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Swedish Arthroplasty Register, Registercentrum Vastra Gotaland, Gothenburg, Sweden.
Örebro University, School of Medical Sciences. Department of Orthopedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Swedish Arthroplasty Register, Registercentrum Vastra Gotaland, Gothenburg, Sweden.
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2024 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 14, no 4, article id e076576Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Prosthetic joint infection (PJI) is a serious complication following total hip arthroplasty (THA) entailing increased mortality, decreased quality of life and high healthcare costs.The primary aim was to investigate whether the national project: Prosthesis Related Infections Shall be Stopped (PRISS) reduced PJI incidence after primary THA; the secondary aim was to evaluate other possible benefits of PRISS, such as shorter time to diagnosis.

DESIGN: Cohort study.

SETTING: In 2009, a nationwide, multidisciplinary infection control programme was launched in Sweden, PRISS, which aimed to reduce the PJI burden by 50%.

PARTICIPANTS: We obtained data on patients undergoing primary THA from the Swedish Arthroplasty Registry 2012-2014, (n=45 723 patients, 49 946 THAs). Using personal identity numbers, this cohort was matched with the Swedish Prescribed Drug Registry. Medical records of patients with ≥4 weeks' antibiotic consumption were reviewed to verify PJI diagnosis (n=2240, 2569 THAs).

RESULTS: The cumulative incidence of PJI following the PRISS Project was 1.2% (95% CI 1.1% to 1.3%) as compared with 0.9% (95% CI 0.8% to 1.0%) before. Cox regression models for the PJI incidence post-PRISS indicates there was no statistical significance difference versus pre-PRISS (HR 1.1 (95% CI 0.9 to 1.3)). There was similar time to PJI diagnosis after the PRISS Project 24 vs 23 days (p=0.5).

CONCLUSIONS: Despite the comprehensive nationwide PRISS Project, Swedish PJI incidence was higher after the project and time to diagnosis remained unchanged. Factors contributing to PJI, such as increasing obesity, higher American Society of Anesthesiology class and more fractures as indications, explain the PJI increase among primary THA patients.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024. Vol. 14, no 4, article id e076576
Keywords [en]
Epidemiology, Hip, Infection control, Primary Prevention
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:oru:diva-113433DOI: 10.1136/bmjopen-2023-076576ISI: 001209953800001PubMedID: 38684253OAI: oai:DiVA.org:oru-113433DiVA, id: diva2:1855190
Funder
Örebro UniversityRegion Örebro County, OLL- 917121
Note

The funding organisations, Research Committee of Örebro University, Region Örebro County (grant no: OLL- 917121), Sweden and Patientforsakringen LOF, Sweden (grant no: NA) provided financial support for the study.

Available from: 2024-04-30 Created: 2024-04-30 Last updated: 2024-06-05Bibliographically approved

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Wildeman, PeterWretenberg, PerSöderquist, Bo

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