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Risk Factors for Surgical Site Infections Following Anterior Cruciate Ligament Reconstruction

Published online by Cambridge University Press:  31 March 2016

Michael V. Murphy*
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Dongyi (Tony) Du
Affiliation:
Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland
Wei Hua
Affiliation:
Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland
Karoll J. Cortez
Affiliation:
Office of Cellular, Tissue and Gene Therapies, Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland
Melissa G. Butler
Affiliation:
Center for Clinical & Outcomes Research, Kaiser Permanentema, Atlanta, Georgia
Robert L. Davis
Affiliation:
Center for Clinical & Outcomes Research, Kaiser Permanentema, Atlanta, Georgia
Thomas A. DeCoster
Affiliation:
Department of Orthopaedics and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, New Mexico
Laura Johnson
Affiliation:
Center for Health Services Research, Henry Ford Health System, Detroit, Michigan
Lingling Li
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Cynthia Nakasato
Affiliation:
Center for Health Research, Kaiser Permanente Hawaii, Honolulu, Hawaii
James D. Nordin
Affiliation:
HealthPartners Institute for Education and Research, Minneapolis, Minnesota
Mayur Ramesh
Affiliation:
Center for Health Services Research, Henry Ford Health System, Detroit, Michigan
Michael Schum
Affiliation:
Health Services Research Division, LCF Research, Albuquerque, New Mexico
Ann Von Worley
Affiliation:
Health Services Research Division, LCF Research, Albuquerque, New Mexico
Craig Zinderman
Affiliation:
Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland
Richard Platt
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Michael Klompas
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
*
Address correspondence to Michael V. Murphy, BA, Harvard Pilgrim Health Care Institute, 401 Park Dr, Ste 401, Boston, MA 02215 (michael.v.murphy@gmail.com).

Abstract

OBJECTIVE

To determine the effect of graft choice (allograft, bone-patellar tendon-bone autograft, or hamstring autograft) on deep tissue infections following anterior cruciate ligament (ACL) reconstructions.

DESIGN

Retrospective cohort study.

SETTING AND POPULATION

Patients from 6 US health plans who underwent ACL reconstruction from January 1, 2000, through December 31, 2008.

METHODS

We identified ACL reconstructions and potential postoperative infections using claims data. A hierarchical stratified sampling strategy was used to identify patients for medical record review to confirm ACL reconstructions and to determine allograft vs autograft tissue implanted, clinical characteristics, and infection status. We estimated infection rates overall and by graft type. We used logistic regression to assess the association between infections and patients’ demographic characteristics, comorbidities, and choice of graft.

RESULTS

On review of 1,452 medical records, we found 55 deep wound infections. With correction for sampling weights, infection rates varied by graft type: 0.5% (95% CI, 0.3%-0.8%) with allografts, 0.6% (0.1%–1.5%) with bone-patellar tendon-bone autografts, and 2.5% (1.9%–3.1%) with hamstring autograft. After adjusting for potential confounders, we found an increased infection risk with hamstring autografts compared with allografts (odds ratio, 5.9; 95% CI, 2.8–12.8). However, there was no difference in infection risk among bone-patellar tendon-bone autografts vs allografts (odds ratio, 1.2; 95% CI, 0.3–4.8).

CONCLUSIONS

The overall risk for deep wound infections following ACL reconstruction is low but it does vary by graft type. Infection risk was highest in hamstring autograft recipients compared with allograft recipients and bone-patellar tendon-bone autograft recipients.

Infect Control Hosp Epidemiol 2016;37:827–833

Type
Original Articles
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Lyman, S, Koulouvaris, P, Sherman, S, Do, H, Mandl, LA, Marx, RG. Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am 2009;91:23212328.CrossRefGoogle ScholarPubMed
2. Crawford, C, Kainer, M, Jernigan, D, et al. Investigation of postoperative allograft-associated infections in patients who underwent musculoskeletal allograft implantation. Clin Infect Dis 2005;41:195200.Google Scholar
3. Greenberg, DD, Robertson, M, Vallurupalli, S, White, RA, Allen, WC. Allograft compared with autograft infection rates in primary anterior cruciate ligament reconstruction. J Bone Joint Surg Am 2010;92:24022408.Google Scholar
4. Katz, LM, Battaglia, TC, Patino, P, Reichmann, W, Hunter, DJ, Richmond, JC. A retrospective comparison of the incidence of bacterial infection following anterior cruciate ligament reconstruction with autograft versus allograft. Arthroscopy 2008;24:13301335.CrossRefGoogle ScholarPubMed
5. Barker, JU, Drakos, MC, Maak, TG, Warren, RF, Williams, RJ 3rd, Allen, AA. Effect of graft selection on the incidence of postoperative infection in anterior cruciate ligament reconstruction. Am J Sports Med 2010;38:281286.Google Scholar
6. Maletis, GB, Inacio, MC, Reynolds, S, Desmond, JL, Maletis, MM, Funahashi, TT. Incidence of postoperative anterior cruciate ligament reconstruction infections: graft choice makes a difference. Am J Sports Med 2013;41:17801785.Google Scholar
7. Maletis, GB, Inacio, MC, Funahashi, TT. Analysis of 16,192 anterior cruciate ligament reconstructions from a community-based registry. Am J Sports Med 2013;41:20902098.CrossRefGoogle Scholar
8. Wang, C, Ao, Y, Wang, J, Hu, Y, Cui, G, Yu, J. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, presentation, treatment, and cause. Arthroscopy 2009;25:243249.Google Scholar
9. Binnet, MS, Basarir, K. Risk and outcome of infection after different arthroscopic anterior cruciate ligament reconstruction techniques. Arthroscopy 2007;23:862868.CrossRefGoogle ScholarPubMed
10. Schulz, AP, Gotze, S, Schmidt, HG, Jurgens, C, Faschingbauer, M. Septic arthritis of the knee after anterior cruciate ligament surgery: a stage-adapted treatment regimen. Am J Sports Med 2007;35:10641069.Google Scholar
11. Van Tongel, A, Stuyck, J, Bellemans, J, Vandenneucker, H. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, management and outcome. Am J Sports Med 2007;35:10591063.Google Scholar
12. Judd, D, Bottoni, C, Kim, D, Burke, M, Hooker, S. Infections following arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 2006;22:375384.Google Scholar
13. Fong, SY, Tan, JL. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Ann Acad Med Singapore 2004;33:228234.Google Scholar
14. Burks, RT, Friederichs, MG, Fink, B, Luker, MG, West, HS, Greis, PE. Treatment of postoperative anterior cruciate ligament infections with graft removal and early reimplantation. Am J Sports Med 2003;31:414418.Google Scholar
15. Schollin-Borg, M, Michaelsson, K, Rahme, H. Presentation, outcome, and cause of septic arthritis after anterior cruciate ligament reconstruction: a case control study. Arthroscopy 2003;19:941947.CrossRefGoogle ScholarPubMed
16. Indelli, PF, Dillingham, M, Fanton, G, Schurman, DJ. Septic arthritis in postoperative anterior cruciate ligament reconstruction. Clin Orthop Relat Res 2002;398:182188.Google Scholar
17. Viola, R, Marzano, N, Vianello, R. An unusual epidemic of Staphylococcus-negative infections involving anterior cruciate ligament reconstruction with salvage of the graft and function. Arthroscopy 2000;16:173177.Google Scholar
18. Williams, RJ 3rd, Laurencin, CT, Warren, RF, Speciale, AC, Brause, BD, O’Brien, S. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Diagnosis and management. Am J Sports Med 1997;25:261267.Google Scholar
19. Baer, GS, Harner, CD. Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction. Clin Sports Med 2007;26:661681.Google Scholar
20. Poehling, GG, Curl, WW, Lee, CA, et al. Analysis of outcomes of anterior cruciate ligament repair with 5-year follow-up: allograft versus autograft. Arthroscopy 2005;21:774785.Google Scholar
21. Strickland, SM, MacGillivray, JD, Warren, RF. Anterior cruciate ligament reconstruction with allograft tendons. Orthop Clin North Am 2003;34:4147.Google Scholar
22. Mallick, TK, Mosquera, A, Zinderman, CE, Martin, LS, Wise, RP. Reported infections after human tissue transplantation before and after new Food and Drug Administration (FDA) regulations, United States, 2001 through June, 2010. Cell Tissue Bank 2012;13:259267.Google Scholar
23. Cartwright, EJ, Prabhu, RM, Zinderman, CE, et al. Transmission of Elizabethkingia meningoseptica (formerly Chryseobacterium meningosepticum) to tissue-allograft recipients: a report of two cases. J Bone Joint Surg Am 2010;92:15011506.CrossRefGoogle ScholarPubMed
24. Mei-Dan, O, Mann, G, Steinbacher, G, Ballester, SJ, Cugat, RB, Alvarez, PD. Septic arthritis with Staphylococcus lugdunensis following arthroscopic ACL revision with BPTB allograft. Knee Surg Sports Traumatol Arthrosc 2008;16:1518.Google Scholar
25. Mroz, TE, Joyce, MJ, Steinmetz, MP, Lieberman, IH, Wang, JC. Musculoskeletal allograft risks and recalls in the United States. J Am Acad Orthop Surg 2008;16:559565.Google Scholar
26. Lee, EH, Ferguson, D, Jernigan, D, et al. Invasive group-A streptococcal infection in an allograft recipient. A case report. J Bone Joint Surg Am 2007;89:20442047.Google Scholar
27. Wang, S, Zinderman, C, Wise, R, Braun, M. Infections and human tissue transplants: review of FDA MedWatch reports 2001-2004. Cell Tissue Bank 2007;8:211219.CrossRefGoogle ScholarPubMed
28. Centers for Disease Control and Prevention. Brief report: investigation into recalled human tissue for transplantation—United States, 2005-2006. MMWR Morb Mortal Wkly Rep 2006;55:564566.Google Scholar
29. Kainer, MA, Linden, JV, Whaley, DN, et al. Clostridium infections associated with musculoskeletal-tissue allografts. N Engl J Med 2004;350:25642571.Google Scholar
30. Barbour, SA, King, W. The safe and effective use of allograft tissue—an update. Am J Sports Med 2003;31:791797.Google Scholar
31. Centers for Disease Control and Prevention. Hepatitis C virus transmission from an antibody-negative organ and tissue donor—United States, 2000-2002. MMWR Morb Mortal Wkly Rep 2003;52:273274, 276.Google Scholar
32. Centers for Disease Control and Prevention. Update: allograft-associated bacterial infections—United States, 2002. MMWR Morb Mortal Wkly Rep 2002;51:207210.Google Scholar
33. Centers for Disease Control and Prevention. Septic arthritis following anterior cruciate ligament reconstruction using tendon allografts—Florida and Louisiana, 2000. MMWR Morb Mortal Wkly Rep 2001;50:10811083.Google Scholar
34. Murphy, MV, Du, DT, Hua, W, et al. The utility of claims data for infection surveillance following anterior cruciate ligament reconstruction. Infect Control Hosp Epidemiol 2014;35:652659.Google Scholar
35. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309332.Google Scholar
36. Tuman, J, Diduch, DR, Baumfeld, JA, Rubino, LJ, Hart, JM. Joint infection unique to hamstring tendon harvester used during anterior cruciate ligament reconstruction surgery. Arthroscopy 2008;24:618620.Google Scholar
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