Authors: Berbari EF, Osmon DR, Hanssen AD, Baddour LM, Greene D, Harmsen WS, Mandrekar JN,Steckelberg JM, Virk A
Title: Prosthetic Joint Infection (PJI) Due To Gastrointestinal (GI) Procedures
Institution: Mayo Clinic College of Medicine, Rochester, MN
Purpose: Many clinicians recommend antibiotic prophylaxis to prevent subsequent prosthetic joint infection following GI procedures, despite that the risk of prosthetic joint infection due to these procedures is unknown.
Methods: We performed a prospective, single-center, case-control study between 2001 and 2006. Cases were patients hospitalized with total hip or knee infection. Controls were patients with a total hip or knee arthroplasty but without a prosthetic joint infection. Data regarding demographic features and potential risk factors were collected. Gastrointestinal procedures in the 254 month prior to the admission date. Logistic regression was used to assess the association of variables with the odds of infection.
Results: There were 339 cases and 339 controls. 23% (79/339) and 21% (69/339) of controls and cases underwent a GI endoscopy (upper or lower GI endoscopy) respectively. There was no increased risk of total hip or knee infection in patients undergoing a GI endoscopy (adjusted OR, 1.3[95%CI: 0.8-2.1]); similar results were obtained for barium enema (adjusted OR, 2[95%CI: 0.6-6.3]), and rectal exam (adjusted OR, 0.8[95%CI: 0.5-1.5]). The results were similar in the subset of patients with joint age of less then 365 days and >365 days. Only 3(0.9%) of control patients and 2(0.6%) case patients received antimicrobial prophylaxis prior to GI endoscopy procedure.
Discussion and Conclusion: GI procedures were not risk factors for subsequent total hip or knee infection.The practice of recommending antibiotic prophylaxis for GI procedures in patients with a joint arthroplasty should be reevaluated.