Risk factors for total joint arthroplasty infection in patients receiving tumor necrosis factor α-blockers: a case-control study. - Archive ouverte HAL Access content directly
Journal Articles Arthritis Research and Therapy Year : 2010

Risk factors for total joint arthroplasty infection in patients receiving tumor necrosis factor α-blockers: a case-control study.

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Abstract

INTRODUCTION: The objective of this study was to assess natural microbial agents, history and risk factors for total joint arthroplasty (TJA) infections in patients receiving tumor necrosis factor (TNF)α-blockers, through the French RATIO registry and a case-control study. METHODS: Cases were TJA infections during TNFα-blocker treatments. Each case was compared to two controls (with TJA and TNFα-blocker therapy, but without TJA infection) matched on age (±15 years), TJA localization, type of rheumatic disorder and disease duration (±15 years). Statistical analyses included univariate and multivariate analyses with conditional logistic regression. RESULTS: In the 20 cases (18 rheumatoid arthritis), TJA infection concerned principally the knee (n = 12, 60%) and the hip (n = 5, 25%). Staphylococcus was the more frequent microorganism involved (n = 15, 75%). Four patients (20%) were hospitalized in an intensive care unit and two died from infection. Eight cases (40%) versus 5 controls (13%) had undergone primary TJA or TJA revision for the joint subsequently infected during the last year (P = 0.03). Of these procedures, 5 cases versus 1 control were performed without withdrawing TNFα-blockers (P = 0.08). In multivariate analysis, predictors of infection were primary TJA or TJA revision for the joint subsequently infected within the last year (odds ratio, OR = 88.3; 95%CI 1.1-7,071.6; P = 0.04) and increased daily steroid intake (OR = 5.0 per 5 mg/d increase; 1.1-21.6; P = 0.03). Case-control comparisons showed similar distribution between TNFα-blockers (P = 0.70). CONCLUSIONS: In patients receiving TNFα-blockers, TJA infection is rare but potentially severe. Important risk factors are primary TJA or TJA revision within the last year, particularly when TNFα-blockers are not interrupted before surgery, and the daily steroid intake.
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inserm-00663730 , version 1 (27-01-2012)

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Mélanie Gilson, Laure Gossec, Xavier Mariette, Dalenda Gherissi, Marie-Hélène Guyot, et al.. Risk factors for total joint arthroplasty infection in patients receiving tumor necrosis factor α-blockers: a case-control study.. Arthritis Research and Therapy, 2010, 12 (4), pp.R145. ⟨10.1186/ar3087⟩. ⟨inserm-00663730⟩
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