Surveillance of surgical site infections cases in prosthetic orthopedics in a French University Hospital, from 2013 to 2016

Introduction Surgical site infections (SSI) in prosthetic orthopedic surgery are infrequent but serious complications. They are responsible for repeated and prolonged hospitalizations, morbidity, and severe disabilities, which can be life-threatening and lead to high hospitalization costs. SSI incidence after total articular prosthesis is estimated between 0.5 and 6% in the United States and between 0.5 and 1% in Europe. In France, in 2015 SSI incidences after total hip arthroplasty (THA) and total knee arthroplasty (TKA) were 0.8% and 0.5%, respectively. The objective is to report SSI incidence trends and to describe SSI cases for patients hospitalized for THA and TKA in a Prosthetic Orthopedic Unit of Lyon University Hospital (LUH), from 2013 to 2016. Methods This surveillance was targeted to adult patients operated on for a scheduled or emergency surgery of THA and TKA in an Orthopedic and Traumatological Surgery Unit of Edouard-Herriot University Hospital (Lyon, France, 1160 beds), from January 1, 2013 to December 31, 2016. Patients’ follow-up lasted one year; all the cases of surgical revision in Orthopedic or Emergency Surgery Unit were identified and consulted, in order to check for a possible infectious reason. All SSI suspected cases were studied and evaluated in collegial discussion, after consultation of patient records, analysis of revision reasons and of bacteriological positive samples. SSI incidence was calculated by % cases/total population of patients operated on from 2013 to 2016 [95% confidence interval (95% CI) is indicated]. Results In total, from 2013 to 2016, 1497 patients have been operated on for arthroplasty (40.3% of TKA, 59.7% of THA); 60.7% of them were women, average age was 68.6 ± 14.4 years. ASA distribution was: 1 (9.5%), 2 (53.6%), 3 (34.7%), 4 (1.5%), 5 (0.1%). Average surgery duration was 105.1 ± 43.4 min (surgery duration  Staphylococcus aureus methicillin sensible; for the remaining cases or as secondary germ, the following bacteria were involved: Staphylococcus epidermidis (3), Escherichia coli (2), Propionibacterium acnes (2), Proteus mirabilis (1), Morganella morganii (1), Raoultella ornithinolytica (1), and unidentified germ (2). Average delay time of infection occurrence was 49.9 ± 48.6 days; 3 SSI cases (16.7%) occurred more than 3 months after surgery. SSI incidence values per year in LUH were: 1.1% in 2013, 0.9% in 2014, 1.2% in 2015 and 1.2% in 2016 for THA; 0.6% in 2013, 1.1% in 2014, 0.8% in 2015 and 3.3% in 2016 for TKA. Conclusions In our university hospital, SSI incidence on prosthetic orthopedics interventions (THA and TKA) from 2013 to 2015 maintained a nearly constant trend, higher than national level (national global incidence from 2013 to 2015: 0.6% [95% CI: 0.6–0.7)]. In 2016, SSI incidence on THA remained constant, while SSI incidence on TKA showed a threefold increase. SSI cases analysis indicated that they were all characterized by known patients (overweight or obesity, insulin-dependent diabetes or immunosuppressive therapies) or intervention risk factors (longer intervention duration). The most frequently identified microorganisms are of cutaneous origin, emphasizing the importance of preoperative preparation, including preoperative showers, depilation and skin disinfection. According to the “National Action Program for the Prevention of Healthcare-Associated Infections” (2015), the objective of SSI incidence on THA and TKA inferior or equal to 1% must be reached and maintained.