Abstract

Objective: To describe the treatment patterns and reoperation rates after claims-defined postoperative periprosthetic joint infection (PJI) identified 1 – 6 months after total knee or hip arthroplasty using a Japanese nationwide claims database.
Materials and methods: Patients who underwent total knee or hip arthroplasty between 2005 and 2017 were identified. Claims-defined postoperative PJI was operationally defined as infection-related claims accompanied by systemic antibacterial treatment in 1 – 6 months after arthroplasty. The agents targeting methicillin-resistant Staphylococcus aureus (MRSA) included vancomycin, daptomycin, linezolid, and teicoplanin. The primary outcome was reoperation after claims-defined postoperative PJI.
Results: Among the 2,805 patients, 59 (2.1%) developed postoperative PJI 1 – 6 months after arthroplasty. Of these, 8 underwent immediate surgical intervention, and the remaining 51 patients were initially managed with antibiotic treatment without surgical intervention. Of these, 12 received anti-MRSA agents and 39 received non-MRSA agents. Reoperation was performed in 3 of 12 (25.0%) patients who received anti-MRSA agents and 6 of 39 (15.4%) patients who did not receive anti-MRSA agents. Among the patients treated with anti-MRSA agents, 11 of 12 (91.7%) required second- or third-line therapy. Diabetes mellitus was present in 66.7% and 83.3% of the reoperated patients who received and did not receive anti-MRSA agents, respectively; liver disease was observed in 66.7% and 16.7% of the patients, respectively.
Conclusion: This claims-based descriptive analysis indicated that treatment escalation and reoperation were observed after claims-defined postoperative PJI identified 1 – 6 months after arthroplasty. Because pathogen data were unavailable and receipt of anti-MRSA agents was used as a treatment-based classification, these findings should be interpreted as descriptive treatment-pattern data rather than microbiologically confirmed comparisons.

Author Details

Authors

• Risa Someya^{1, 2}
• Kosuke Takata^{1, 2}
• Takeshi Uchikura²
• Yusuke Oshita³
• Kenji Momo⁴

Departments

• ¹ Department of Pharmacy, Showa Medical University Northern Yokohama Hospital, Yokohama,
• ² Division of Hospital Pharmaceutics, Department of Hospital Pharmaceutics, School of Pharmacy, Showa Medical University, Tokyo,
• ³ Department of Orthopedic Surgery, Showa Medical University Northern Yokohama Hospital, Yokohama, and
• ⁴ Division of Clinical Research, Department of Hospital Pharmaceutics, School of Pharmacy, Showa Medical University, Tokyo, Japan

Address

Associate Prof. Kenji Momo, PhD
Division of Clinical Research
Department of Hospital Pharmaceutics
School of Pharmacy, Showa Medical University
Hatanodai 1-5-8, Shinagawa-ku
Tokyo 142-8555, Japan
Email: [email protected]

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